Graphical user interface for real-time RF lesion depth display

ABSTRACT

A system for displaying characteristics of target tissue during an ablation procedure is provided that includes an electronic control unit (ECU) configured to receive data regarding electrical properties of the target tissue for a time period. The ECU is also configured to determine a value responsive to the data and indicative of at least one of a predicted depth of a lesion in the target tissue, a predicted temperature of the target tissue, and a likelihood of steam pop of the target tissue for the time period. The system further includes a display device operatively connected to the ECU. The display device is configured to receive the value and display a visual representation indicative of at least one of a predicted depth of a lesion in the target tissue, a predicted temperature of the target tissue, and a likelihood of steam pop of the target tissue for the time period.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation-in-part of U.S. patent applicationSer. No. 12/946,941 entitled “System and Method for Assessing theFormation of a Lesion in Tissue,” filed Nov. 16, 2010 (the '941application), now pending, the entire disclosure of which isincorporated by reference. The '941 application is acontinuation-in-part of U.S. patent application Ser. No. 12/622,488entitled “System and Method for Assessing Lesions in Tissue,” filed Nov.20, 2009 and currently pending, the entire disclosure of which isincorporated herein by reference. U.S. patent application Ser. No.12/622,488 claimed the benefit of U.S. Provisional Application Ser. No.61/177,876 entitled “System and Method for Assessing Lesions in Tissue”filed May 13, 2009, and is a continuation-in-part of U.S. patentapplication Ser. No. 12/253,637 entitled “System and Method forAssessing Coupling Between an Electrode and Tissue” filed Oct. 17, 2008and currently pending, the entire disclosures of which are incorporatedherein by reference. U.S. patent application Ser. No. 12/253,637 is, inturn, a continuation-in-part of U.S. patent application Ser. No.12/095,688 entitled “Assessment of Electrode Coupling of TissueAblation” filed May 30, 2008 and currently pending, the entiredisclosure of which is incorporated herein by reference. U.S. patentapplication Ser. No. 12/095,688 is a national stage application of, andclaims priority to, International Application No. PCT/US2006/061714entitled “Assessment Of Electrode Coupling For Tissue Ablation” filedDec. 6, 2006, the entire disclosure of which is hereby incorporated byreference. The International Application was published in the Englishlanguage on Jun. 14, 2007 as International Publication No. WO2007/067941 A2 and itself claims the benefit of U.S. Provisional PatentApplication No. 60/748,234 filed Dec. 6, 2005, the entire disclosure ofwhich is incorporated herein by reference.

This application is also a continuation-in-part of U.S. patentapplication Ser. No. 12/353,897 entitled “System And Method ForDisplaying Contact Between A Catheter And Tissue,” filed Jan. 14, 2009(the '897 application), now pending, the entire disclosure of which isincorporated by reference. The '897 application claimed the benefit ofU.S. provisional application No. 61/020,806 entitled “Display OfInformation Such As Complex Impedance In Close Proximity To AdvancedElectro-Anatomical Maps And Catheter Renderings,” filed Jan. 14, 2008.The '897 application is also a continuation-in-part of U.S. patentapplication Ser. No. 12/253,637 entitled “System and Method forAssessing Coupling Between an Electrode and Tissue”, filed Oct. 17,2008, now pending, which is a continuation-in-part of U.S. patentapplication Ser. No. 12/095,688 entitled “Assessment of ElectrodeCoupling of Tissue Ablation”, filed May 30, 2008, now pending. U.S.patent application Ser. No. 12/095,688 is a national stage applicationof, and claims priority to, International Application No.PCT/US2006/061714 entitled “Assessment Of Electrode Coupling For TissueAblation”, filed Dec. 6, 2006. The International Application waspublished in the English language on Jun. 14, 2007 as InternationalPublication No. WO 2007/067941 A2 and itself claims the benefit of U.S.provisional application No. 60/748,234, filed Dec. 6, 2005. All of theforegoing are hereby incorporated herein by reference as though fullyset forth herein.

This application also claims the benefit of U.S. provisional applicationNo. 61/285,756 entitled “System And Method For Determining TheLikelihood Of Endocardial Barotrauma In Tissue During Ablation”, filed11 Dec. 2009, which is hereby incorporated by reference as though fullyset forth herein.

BACKGROUND OF THE INVENTION

a. Field of the Invention

This disclosure relates to a system and method for assessing theformation of a lesion in target tissue and displaying a visualrepresentation indicative of the characteristics of a lesion formed inthe target tissue. More particularly, this disclosure relates to asystem and method for assessing the depth of a lesion formed in thetarget tissue and displaying a visual representation indicative of thedepth of the lesion formed in the target tissue. The system and methodmay also display a visual representation indicative of the thickness ofthe target tissue and provide a visual representation indicative of thedepth of the lesion formed in the target tissue relative to thethickness of the target tissue (i.e., provide information regarding thetransmurality of the lesion). The system and method may also display avisual representation indicative of the likelihood a lesion has reacheda predetermined depth, the temperature of the target tissue during anablation procedure being performed on the target tissue, and/or thelikelihood of steam pop during an ablation procedure being performed onthe target tissue.

b. Background Art

It is known that ablation therapy may be used to treat variousconditions afflicting the human anatomy. One such condition thatablation therapy finds particular applicability is in the treatment ofatrial arrhythmias, for example. When tissue is ablated, or at leastsubjected to ablative energy generated by an ablation generator anddelivered by an ablation catheter, lesions form in the tissue. Moreparticularly, electrode mounted on or in the ablation catheter are usedto create tissue necrosis in cardiac tissue to correct conditions suchas atrial arrhythmia (including, but not limited to, ectopic atrialtachycardia, atrial fibrillation, and atrial flutter). Atrialarrhythmias can create a variety of dangerous conditions includingirregular heart rates, loss of synchronous atrioventricular contractionsand stasis of blood flow which can lead to a variety of ailments andeven death. It is believed that the primary cause of atrial arrhythmiais stray electrical signals within the left or right atrium of theheart. The ablation catheter imparts ablative energy (e.g., radiofrequency energy, cryoablation, lasers, chemicals, high-intensityfocused ultrasound, etc.) to cardiac tissue to create a lesion in thecardiac tissue. The lesion disrupts undesirable electrical pathways andthereby limits or prevents stray electrical signals that lead toarrhythmias.

One challenge with ablation procedures is in the assessment of thelesion formation as a result of the application of ablative energy tothe tissue. For example, it is difficult to evaluate, assess, and/ordetermine the depth of a lesion in the tissue. As such, it is difficultto determine whether the tissue has been sufficiently or acceptablyablated, or at least whether a lesion has reached a desired depth.Lesion formation has typically been fairly crudely assessed.

For example, conventional techniques to assess lesion formation, andparticularly, lesion depth, have included monitoring the impedance onthe ablation generator and monitoring electrogram reduction as theablation procedure is performed and progresses. However, conventionaltechniques have proved to be less than optimal as none of theconventional techniques provide an accurate means by which the depth ofa lesion, for example, can be predicted with any real certainty.Accordingly, it is also difficult to determine whether a lesion istransmural (i.e., that the lesion extends through the entire thicknessof the target tissue) and may be useful in connection with blockingarrythmias and/or atrial fibrillation.

By providing information to the clinician regarding lesion formation intarget tissue as a result of an ablation procedure being performedthereon, lesion creation may be completed in a safer, more efficaciousmanner with a greater chance of transmural lesions and a lesser chanceof collateral damage when performing an ablation procedure on thintarget tissue.

Accordingly, the inventors herein have recognized a need for a systemand method for assessing lesion formation in target tissue as a resultof an ablation procedure being performed thereon and displayinginformation regarding lesion formation in target tissue that willminimize and/or eliminate one or more of the deficiencies inconventional ablation systems.

BRIEF SUMMARY OF THE INVENTION

The present invention is directed to a method and system for displayingcharacteristics of target tissue during an ablation procedure. Thesystem according to the present teachings includes an electronic controlunit (ECU). The ECU is configured to receive as an input data regardingthe electrical properties of the target tissue for a time period. Thedata regarding the electrical properties of the target tissue may begenerated by measuring electrical properties of the target tissue with asensor on an ablation catheter.

The ECU is further configured to determine a value responsive to thedata and indicative of at least one of a predicted depth of a lesion inthe target tissue, a predicted temperature of the target tissue, and alikelihood of steam pop of the target tissue for the time period. TheECU is further configured to output the value. The system according tothe present teachings further includes a display device operativelyconnected to the ECU. The display device is configured to receive thevalue and display a visual representation indicative of at least one ofa predicted depth of a lesion in the target tissue, a predictedtemperature of the target tissue, and a predicted likelihood of steampop of the target tissue for the time period. In an exemplaryembodiment, the visual representation is displayed during the timeperiod. In one embodiment, the ECU is configured to store the value, toretrieve the stored value subsequent to the time period, and to outputthe stored value to the display device subsequent to the time period. Inthis embodiment, the display device is configured to display a visualrepresentation corresponding to the stored value and indicative of atleast one of a predicted depth of a lesion in the target tissue, apredicted temperature of the target tissue, and a likelihood of steampop of the target tissue subsequent to the time period.

In an exemplary embodiment, the ECU is further configured to receive asan input data regarding the thickness of the target tissue. The displaydevice may be further configured to display a visual representationindicative of the thickness of the target tissue. The display device mayalso be further configured to display a visual representation indicativeof the transmurality of a lesion in the target tissue.

The format of the visual representation indicative of at least one of apredicted depth of a lesion in the target tissue, a predictedtemperature of the target tissue, and a predicted likelihood of steampop of the target tissue for the time period may vary and may compriseany number of representations in accordance with various embodiments ofthe invention. For example, the representation may comprise anexpandable graph or meter, a gauge including a scale and an indicatormoveable along the scale, and/or a color in accordance with an exemplaryembodiment of the invention. For example, the expandable graph or metermay be at least partially overlaid over the visual representationindicative of the thickness of the target tissue. For another example,the system may be configured to store a first color associated with afirst range of values indicative of at least one of a predicted depth ofa lesion in the target tissue, a predicted temperature of the targettissue, and a predicted likelihood of steam pop of the target tissue forthe time period. The system may further be configured to store a secondcolor associated with a second range of values indicative of at leastone of a predicted depth of a lesion in the target tissue, a predictedtemperature of the target tissue, and a predicted likelihood of steampop of the target tissue for the time period. The system may further beconfigured to store a third color associated with a third range ofvalues indicative of at least one of a predicted depth of a lesion inthe target tissue, a predicted temperature of the target tissue, and apredicted likelihood of steam pop of the target tissue for the timeperiod. The system may then be configured to display a color associatedwith the value indicative of at least one of a predicted depth of alesion in the target tissue, a predicted temperature of the targettissue, and a predicted likelihood of steam pop of the target tissue forthe time period.

The display device may be further configured to display a slider barconfigured to adjust a threshold against which the value indicative ofat least one of a predicted depth of a lesion in the target tissue, apredicted temperature of the target tissue, and a likelihood of steampop of the target tissue may be compared, thereby adjusting asensitivity of the graphical user interface system.

The display device may further be configured to display a visualrepresentation indicative of an ablation catheter used to perform theablation procedure in accordance with an exemplary embodiment. This mayinclude a first view along a first axis of a body upon which theablation procedure is performed and a second view along a second axis ofthe body upon which the ablation procedure is performed.

In accordance with another aspect of the invention, the system fordisplaying characteristics of target tissue during an ablation procedureincludes an ablation catheter including a sensor configured forobtaining data regarding the electrical properties of the target tissuefor a time period; an electroanatomic visualization, mapping, andnavigation system configured for generating an anatomical model of atleast the target tissue, the electroanatomic visualization, mapping, andnavigation system including a display device for displaying theanatomical model; and a graphical user interface system as describedhereinabove. The visual representation indicative of one of a predicteddepth of a lesion in the target tissue, a predicted temperature of thetarget tissue, and a predicted likelihood of steam pop of the targettissue for the time period may appear as an inset on the display deviceof the electromagnetic visualization, mapping, and navigation system inaccordance with an embodiment of the invention. The display device maybe further configured to receive the value and display a visualrepresentation indicative of a location of the ablation catheter used toperform the ablation procedure relative to the anatomical modelgenerated by the electroanatomic visualization, mapping, and navigationsystem.

In accordance with an exemplary embodiment, at least one of the displaydevice and the ablation catheter may be configured to present at leastone of an audible indication, a tactile indication, and a vibrationalindication if the value indicative of one of a predicted depth of alesion in the target tissue, a predicted temperature of the targettissue, and a predicted likelihood of steam pop of the target tissue forthe time period exceeds a predetermined threshold.

In accordance with another aspect of the invention, a method fordisplaying characteristics of target tissue during an ablation procedureis provided. In accordance with the present teachings, the methodincludes the steps of obtaining data regarding the thickness of thetarget tissue; displaying a visual representation indicative of thethickness of the target tissue; obtaining data regarding the electricalproperties of the target tissue for a time period; determining a valueresponsive to the data regarding the electrical properties of the targettissue that is indicative of one of a predicted depth of a lesion in thetarget tissue, a predicted temperature of the target tissue, and apredicted likelihood of steam pop of the target tissue for the timeperiod; and displaying a visual representation indicative of one of apredicted depth of a lesion in the target tissue, a predictedtemperature of the target tissue, and a predicted likelihood of steampop of the target tissue for the time period.

The foregoing and other aspects, features, details, utilities, andadvantages of the present invention will be apparent from reading thefollowing description and claims, and from reviewing the accompanyingdrawings.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a diagrammatic view of a system in accordance with the presentteachings.

FIG. 2 is a simplified schematic diagram illustrating how impedance isdetermined in accordance with the present teachings.

FIG. 3 is a diagrammatic and block diagram illustrating the approach inFIG. 2 in greater detail.

FIG. 4 is flow chart illustrative of an exemplary embodiment of a methodfor assessing the formation of a lesion in tissue during an ablationprocedure performed on the tissue in accordance with the presentteachings.

FIG. 5 is a chart illustrating results of validation testing of anexemplary lesion depth prediction algorithm.

FIG. 6 is a flow chart illustrative of an exemplary embodiment of themethodology illustrated in FIG. 4 shown in greater detail.

FIG. 7 is a table showing an exemplary embodiment of how data acquiredby the system of FIG. 1 is organized and/or stored.

FIGS. 8a-8n are exemplary embodiments of screen displays illustratingpossible formats for presenting predicted lesion depths calculated usingthe methodology of FIG. 6.

FIGS. 9a-9b are flow charts illustrative of exemplary embodiments ofmethodologies for using predicted lesion depths calculated using themethodology of FIG. 6.

FIG. 10 is a flow chart illustrative of another exemplary embodiment ofthe methodology illustrated in FIG. 4 shown in greater detail.

FIG. 11 is a table showing another exemplary embodiment of how dataacquired by the system of FIG. 1 is organized and/or stored.

FIGS. 12 and 13 are exemplary embodiments of screen displaysillustrating possible formats for presenting a prediction or likelihoodof whether a lesion has attained a predetermined depth calculated usingthe methodology of FIG. 10.

FIG. 14 is a flow chart illustrative of another exemplary embodiment ofthe methodology illustrated in FIG. 4 shown in greater detail.

FIG. 15 is a table showing another exemplary embodiment of how dataacquired by the system of FIG. 1 is organized and/or stored.

FIG. 16 is an isometric diagrammatic view of a robotic catheter systemillustrating an exemplary layout of various system components inaccordance with the present teachings.

FIG. 17 is an isometric diagrammatic view of an exemplary embodiment ofa robotic catheter manipulator support structure in accordance with thepresent teachings.

FIG. 18 is a schematic diagram of a magnetic-based catheter manipulationsystem in accordance with the present teachings.

DETAILED DESCRIPTION OF THE INVENTION

Referring now to the drawings wherein like reference numerals are usedto identify identical components in the various views, FIG. 1illustrates one exemplary embodiment of a system 10 configured, at leastin part, for assessing the formation of a lesion in a tissue 12 of abody 14 as a result of an ablation procedure being performed on thetissue 12. In an exemplary embodiment wherein the tissue 12 is cardiactissue, the system 10 is configured to assess the formation of a lesionin the tissue 12 being ablated by radio frequency (RF) energy or powerdelivered from an electrode 16 disposed on a catheter 18. For the sakeof clarity and brevity alone, the description set forth below will bewith respect to cardiac tissue only. It should be understood, however,that the present disclosure may find application in connection withassessing lesion depth in other types of tissue during ablationprocedures. Accordingly, the present disclosure is not meant to belimited solely to cardiac tissue.

In addition to the electrode 16 and the catheter 18, the system 10 mayinclude patch electrodes 20, 22, 24, an ablation generator 26, a tissuesensing circuit 28, an electrophysiology (EP) monitor 30, and a system32 for visualization, mapping, and navigation of internal bodystructures, which may include an electronic control unit 34 and adisplay device 36, among other components.

The catheter 18 is provided for examination, diagnosis and treatment ofinternal body tissues such as the tissue 12. In accordance with oneembodiment, the catheter 18 comprises an ablation catheter and, moreparticularly, an irrigated radio-frequency (RF) ablation catheter. In anexemplary embodiment, the catheter 18 is connected to a fluid source 38having a biocompatible fluid, such as saline through a pump 40 (whichmay comprise, for example, a fixed rate roller pump or variable volumesyringe pump with a gravity feed supply from the fluid source 38 asshown), for irrigation. It should be noted, however, that the presentdisclosure is not meant to be limited to irrigated catheters, but ratherit may find applicability with any number of electrode and ablationdevice combinations. In an exemplary embodiment, the catheter 18 is alsoelectrically connected to the ablation generator 26 for delivery of RFenergy or power. The catheter 18 may include a cable connector orinterface 42, a handle 44, a shaft 46 having a proximal end 48 and adistal 50 end (as used herein, “proximal” refers to a direction towardthe end of the catheter near the clinician, and “distal” refers to adirection away from the clinician and (generally) inside the body of apatient) and one or more electrodes 16, 52, 54, 55. The catheter 18 mayalso include other conventional components, such as, for example, atemperature sensor (e.g., a thermocouple or temperature-sensingelectrode, for example) for sensing the temperature of the tip of thecatheter 18, other additional electrodes and corresponding conductors orleads not illustrated herein, or additional ablation elements (e.g., ahigh intensity focused ultrasound ablation element).

The connector 42 provides mechanical, fluid and electrical connection(s)for cables 56, 58 extending, for example, from the pump 40 and theablation generator 26. The connector 42 is conventional in the art andis disposed at the proximal end 48 of the catheter 18.

The handle 44 provides a location for the clinician to hold the catheter18 and may further provide a means for steering or the guiding of theshaft 46 within the body 14. For example, the handle 44 may includemeans to change the length of a guidewire extending through the catheter18 to the distal end 50 of the shaft 46 to steer the shaft 46. Thehandle 44 is also conventional in the art and it will be understood thatthe construction of the handle 44 may vary. In an alternate exemplaryembodiment to be described in greater detail below, the catheter 18 maybe robotically or magnetically driven or controlled. Accordingly, ratherthan a clinician manipulating a handle to steer or guide the catheter18, and the shaft 46 thereof, in particular, a robot or a magnetic-basedsystem is used to manipulate the catheter 18.

The shaft 46 is an elongated, tubular, flexible member configured formovement within the body 14. The shaft 46 supports the electrodes 16,52, 54, 55, associated conductors, and possibly additional electronicsused, for example, for signal processing or conditioning. The shaft 46may also permit transport, delivery and/or removal of fluids (includingirrigation fluids, cryogenic ablation fluids, and bodily fluids),medicines, and/or surgical tools or instruments. The shaft 46 may bemade from conventional materials such as polyurethane and defines one ormore lumens configured to house and/or transport electrical conductors,fluids or surgical tools. The shaft 46 may be introduced directly into ablood vessel or other structure within the body 14, or may be introducedthrough a conventional introducer. The shaft 46 may then be steered orguided through the body 14 to a desired location such as the tissue 12with guidewires or other means known in the art.

The electrodes 16, 52, 54, 55 are provided for a variety of diagnosticand therapeutic purposes including, for example, electrophysiologicalstudies, catheter identification and location, pacing, cardiac mapping,temperature sensing, and ablation. In the illustrated embodiment, thecatheter 18 includes an ablation tip electrode 16 at the distal end 50of the shaft 46, a plurality of ring electrodes 52, 54, 55. The catheter18 may include a temperature sensor. In some embodiments, one of theelectrodes 52, 54, 55 may comprise a temperature-sensing electrode. Inother embodiments, the catheter 18 may include an additional temperaturesensor. It should be understood, however, that the number, shape,orientation, and purpose of the electrodes 16, 52, 54, 55 may vary.Accordingly, the illustrated embodiment is provided for exemplarypurposes only.

The patch electrodes 20, 22, 24 provide RF or navigational signalinjection paths and/or are used to sense electrical potentials. Theelectrodes 20, 22, 24 may also have additional purposes, such as, forexample, facilitating the generation of an electromechanical map by theelectrodes 16, 52, 54, 55. The electrodes 20, 22, 24 are made fromflexible, electrically conductive material and are configured foraffixation to the body 14 such that the electrodes 20, 22, 24 are inelectrical contact with the patient's skin. The electrode 20 mayfunction as an RF indifferent/dispersive return for the RF ablationsignal. The electrodes 22, 24 may function as returns for the RFablation signal source and/or an excitation signal generated by thetissue sensing circuit 28 as described in greater detail hereinbelow. Inaccordance with one aspect of the present disclosure discussedhereinbelow, the electrodes 22, 24 are preferably spaced relatively farapart. In the illustrated embodiment, the electrodes 22, 24, are locatedon the medial aspect of the left leg and the dorsal aspect of the neck.The electrodes 22, 24, may alternatively be located on the front andback of the torso or in other conventional orientations.

The ablation generator 26 generates, delivers, and controls RF energyoutput by the ablation catheter 18, and the electrode 16, in particular.The generator 26 is conventional in the art and may comprise thecommercially available unit sold under the model number IBI-1500T-11 RFCardiac Ablation Generator, available from Irvine Biomedical, Inc. Thegenerator 26 includes an RF ablation signal source 60 configured togenerate an ablation signal that is output across a pair of sourceconnectors: a positive polarity connector SOURCE (+) which may connectto the tip electrode 16; and a negative polarity connector SOURCE (−)which may be electrically connected by conductors or lead wires to oneof the patch electrodes 20, 22, 24 (see FIG. 2). It should be understoodthat the term connectors as used herein does not imply a particular typeof physical interface mechanism, but is rather broadly contemplated torepresent one or more electrical nodes. The source 60 is configured togenerate a signal at a predetermined frequency in accordance with one ormore user specified parameters (e.g., power, time, etc.) and under thecontrol of various feedback sensing and control circuitry as is know inthe art. The source 60 may generate a signal, for example, with afrequency of about 200 kHz or greater. The generator 26 may also monitorvarious parameters associated with the ablation procedure includingimpedance, the temperature at the tip of the catheter, ablation energy,and the position of the catheter and provide feedback to the clinicianregarding these parameters. The impedance measurement output by atypical currently available generator reflects the magnitude ofimpedance not only at the tissue 12, but the entire impedance betweenthe tip electrode 16 and the corresponding patch electrode 20 on thebody surface. In an exemplary embodiment, the ablation generator 26 maygenerate a higher frequency current for the purposes of RF ablation, anda second lower frequency current for the purpose of measuring impedance.

The tissue sensing circuit 28 provides a means, such as a tissue sensingsignal source 62, for generating an excitation signal used in impedancemeasurements and means, such as a complex impedance sensor 64, forresolving the detected impedance into its component parts. In anotherexemplary embodiment, the complex impedance may be measured usingcomponents other than the tissue sensing circuit 28, such as, forexample, the ablation generator 26. However, in an embodiment whereinthe tissue sensing circuit 28 is used, the signal source 62 isconfigured to generate an excitation signal across source connectorsSOURCE (+) and SOURCE (−) (See FIG. 2). The source 62 may output asignal having a frequency within a range from about 1 kHz to over 500kHz. In an exemplary embodiment, the frequency is about 20 kHz. In oneexemplary embodiment, the excitation signal is a constant current signalthat, in an exemplary embodiment, is in the range of between 20-200 μA.In another exemplary embodiment, the current is about 100 μA. Asdiscussed below, the constant current AC excitation signal generated bythe source 62 is configured to develop a corresponding AC responsevoltage signal that is dependent on the complex impedance of the tissue12 and is sensed by the complex impedance sensor 64. The sensor 64resolves the complex impedance into its component parts (i.e., theresistance (R) and reactance (X), or the impedance magnitude (|Z|) andphase angle (∠Z or φ)). Sensor 64 may include conventional filters(e.g., bandpass filters) to block frequencies that are not of interest,but permit appropriate frequencies, such as the excitation frequency, topass, as well as conventional signal processing software used to obtainthe component parts of the measured complex impedance.

It should be understood that variations are contemplated by the presentdisclosure. For example, the excitation signal may be an AC voltagesignal where the response signal comprises an AC current signal.Nonetheless, in an exemplary embodiment, a constant current excitationsignal is employed. It should be appreciated that in an exemplaryembodiment the excitation signal frequency is outside of the frequencyrange of the RF ablation signal, which allows the complex impedancesensor 64 to more readily distinguish the two signals, and facilitatesfiltering and subsequent processing of the AC response voltage signal.In an exemplary embodiment, the excitation signal frequency is alsooutside the frequency range of conventionally expected electrogram (EGM)signals in the frequency range of 0.05 Hz-1 kHz. Thus, in summary, in anexemplary embodiment the excitation signal has a frequency that is abovethe typical EGM signal frequencies and below the typical RF ablationsignal frequencies. Additionally, in certain embodiments multipleexcitation signals of different frequencies may be used to determinemultiple complex impedances. For example, in one exemplary embodiment, a20 kHz signal and a 200 kHz signal may be generated and a compleximpedance corresponding to each may be determined and used as will bedescribed below. Accordingly, the present invention is not limited to anembodiment wherein a single excitation signal is employed, but ratherincludes embodiments wherein multiple excitation signals are used. Forthe sake of clarity and brevity, however, the following description willbe limited to the embodiment wherein a single excitation signal is use.

The circuit 28 is also connected, for a purpose described hereinbelow,across a pair of sense connectors: a positive polarity connector SENSE(+) which may connect to the tip electrode 16; and a negative polarityconnector SENSE (−) which may be electrically connected to one of thepatch electrodes 20, 22, 24 (see FIG. 2; note, however, that theconnector SENSE (−) should be connected to a different electrode of theelectrodes 20, 22, 24 relative to the connector SOURCE (−) as discussedbelow). It should again be understood that the term connectors as usedherein does not imply a particular type of physical interface mechanism,but is rather broadly contemplated to represent one or more electricalnodes.

Referring now to FIG. 2, connectors SOURCE (+), SOURCE (−), SENSE (+)and SENSE (−) form a three terminal arrangement permitting measurementof the complex impedance at the interface of the tip electrode 16 andthe tissue 12. Complex impedance can be expressed in rectangularcoordinates as set forth in equation (1):Z=R+jX  (1)where R is the resistance component (expressed in ohms); and X is areactance component (also expressed in ohms). Complex impedance can alsobe expressed polar coordinates as set forth in equation (2):Z=r·e ^(jθ) =|Z|∠θ  (2)where |Z| is the magnitude of the impedance (expressed in ohms) and ∠Z=θis the phase angle expressed in radians. Alternatively, the phase anglemay be expressed in terms of degrees where

$\phi = {\left( \frac{180}{\pi} \right){\theta.}}$Throughout the remainder of this specification, phase angle will bepreferably referenced in terms of degrees. The three terminals comprise:(1) a first terminal designated “A-Catheter Tip” which is the tipelectrode 16; (2) a second terminal designated “B-Patch 1” such as thesource return patch electrode 24; and (3) a third terminal designated“C-Patch 2” such as the sense return patch electrode 22. In addition tothe ablation (power) signal generated by the source 60 of the ablationgenerator 26, the excitation signal generated by the source 62 in thetissue sensing circuit 28 is also be applied across the sourceconnectors (SOURCE (+), SOURCE (−)) for the purpose of inducing aresponse signal with respect to the load that can be measured and whichdepends on the complex impedance.

As described above, in one embodiment, a 20 kHz, 100 μA AC constantcurrent signal is sourced along a path 66, as illustrated, from oneconnector (SOURCE (+), starting at node A) through the common node (nodeD) to a return patch electrode (SOURCE (−), node B). The compleximpedance sensor 64 is coupled to the sense connectors (SENSE (+), SENSE(−)), and is configured to determine the impedance across a path 68. Forthe constant current excitation signal of a linear circuit, theimpedance will be proportional to the observed voltage developed acrossSENSE (+)/SENSE (−), in accordance with Ohm's Law: Z=V/I. Becausevoltage sensing is nearly ideal, the current flows through the path 66only, so the current through the path 68 (node D to node C) due to theexcitation signal is effectively zero. Accordingly, when measuring thevoltage along the path 68, the only voltage observed will be where thetwo paths intersect (i.e., from node A to node D). Depending on thedegree of separation of the two patch electrodes (i.e., those formingnodes B and C), an increasing focus will be placed on the tissue volumenearest the tip electrode 16. If the patch electrodes are physicallyclose to each other, the circuit pathways between the catheter tipelectrode 16 and the patch electrodes will overlap significantly andimpedance measured at the common node (i.e., node D) will reflectimpedances not only at the interface of the catheter electrode 16 andthe tissue 12, but also other impedances between the tissue 12 and thesurface of body 14. As the patch electrodes are moved further apart, theamount of overlap in the circuit paths decreases and impedance measuredat the common node is only at or near the tip electrode 16 of thecatheter 18.

Referring now to FIG. 3, the concept illustrated in FIG. 2 is extended.FIG. 3 is a simplified schematic and block diagram of the three-terminalmeasurement arrangement of the invention. For clarity, it should bepointed out that the SOURCE (+) and SENSE (+) lines may be joined in thecatheter connector or the handle (as in solid line) or may remainseparate all the way to the tip electrode 16 (the SENSE (+) line beingshown in phantom line from the handle to the tip electrode 16). FIG. 3shows, in particular, several sources of complex impedance variations,shown generally as blocks 70, that are considered “noise” because suchvariations do not reflect the physiologic changes in the tissue whosecomplex impedance is being measured. For reference, the tissue 12 whosecomplex impedance is being measured is that near and around the tipelectrode 16 and is enclosed generally by a phantom-line box 72 (and thetissue 12 is shown schematically, in simplified form, as aresistor/capacitor combination). One object of the present disclosure isto provide a measurement arrangement that is robust or immune tovariations that are not due to changes in or around the box 72. Forexample, the variable complex impedance boxes 70 that are shown inseries with the various cable connections (e.g., in the SOURCE (+)connection, in the SOURCE (−) and SENSE (−) connections, etc.) mayinvolve resistive/inductive variations due to cable length changes,cable coiling and the like. The variable complex impedance boxes 70 thatare near the patch electrodes 22, 24, may be more resistive/capacitivein nature, and may be due to body perspiration and the like over thecourse of a study. As will be seen, the various arrangements of thesystem 10 are relatively immune to the variations in the blocks 70,exhibiting a high signal-to-noise (S/N) ratio as to the compleximpedance measurement for the block 72.

Although the SOURCE (−) and SENSE (−) returns are illustrated in FIG. 3as patch electrodes 22, 24, it should be understood that otherconfigurations are possible. In particular, the indifferent/dispersivereturn electrode 20 can be used as a return, as well as anotherelectrode 52, 54 on the catheter 18, such as the ring electrode 52 asdescribed in commonly assigned U.S. patent application Ser. No.11/966,232 filed on Dec. 28, 2007 and titled “System and Method forMeasurement of an Impedance using a Cather such as an AblationCatheter,” the entire disclosure of which is incorporated herein byreference.

The EP monitor 30 is provided to display electrophysiology dataincluding, for example, an electrogram. The monitor 30 is conventionalin the art and may comprise an LCD or CRT monitor or anotherconventional monitor. The monitor 30 may receive inputs from theablation generator 26 as well as other conventional EP lab componentsnot shown in the illustrated embodiment.

The system 32 is provided for visualization, mapping, and navigation ofinternal body structures. The system 32 may comprise the system havingthe model name EnSite NavX™ and commercially available from St. JudeMedical, Inc., and as generally shown with reference to commonlyassigned U.S. Pat. No. 7,263,397 entitled “Method and Apparatus forCatheter Navigation and Location and Mapping in the Heart,” the entiredisclosure of which is incorporated herein by reference. Alternativesystems may include, for example and without limitation, the Carto™System available from Biosense Webster, and as generally shown withreference to U.S. Pat. Nos. 6,498,944 entitled “Intrabody Measurement”and 6,788,967 entitled “Medical Diagnosis, Treatment and ImagingSystems,” both of which are incorporated herein by reference in theirentireties; commonly available fluoroscopy systems; or a magneticlocation system, such as, for example, the gMPS system from MediGuideLtd., and as generally shown with reference to U.S. Pat. No. 7,386,339entitled “Medical Imaging and Navigation System,” the disclosure ofwhich is incorporated herein by reference in its entirety. The system 32may include the electronic control unit (ECU) 34 and the display device36 among other components. In another exemplary embodiment, the ECU 34and/or the display device 36 are separate and distinct components thatare electrically connected to, and configured for communication with,the system 32.

With reference to FIG. 4, the ECU 34 is configured to acquire amagnitude for one or more components of a complex impedance between theelectrode 16 and the tissue 12 (i.e., the resistance (R) and reactance(X), or the impedance magnitude (|Z|) and phase angle (φ), or anycombination of the foregoing or derivatives or functional equivalentsthereof) (Step 100 in FIG. 4), as well as one or more magnitudes for thepower or energy applied to the tissue 12 by the ablation generator 26during the formation of a lesion in the tissue 12 (Step 102 in FIG. 4).The ECU 34 is further configured to calculate a value responsive to themagnitude(s) of the one or more components of the complex impedance andthe magnitude of the applied power (Step 104 in FIG. 4), with the valuebeing indicative of one of a predicted depth of the lesion formed in thetissue 12, a likelihood of the lesion in the tissue 12 reaching apredetermined depth, and a predicted temperature of the tissue 12. Aswill be described in greater detail below, in an embodiment wherein thevalue is indicative of the temperature of the tissue, the temperature isthe temperature of the tissue a predetermined depth below theendocardial surface of the tissue 12. In one embodiment provided forexemplary purposes only, this predetermined depth is three millimeters(3 mm) below the endocardial surface.

In an embodiment of the system 10 such as that briefly described abovewherein multiple excitation signals are utilized to determine multiplecomplex impedances, the ECU 34 may be configured to acquire one or morecomponents of one or both of the complex impedances for calculating thevalue. For the sake of clarity and brevity, the following descriptionwill be limited to the calculation of the value using a single compleximpedance. It should be understood, however, that the present disclosureis not meant to be limited to such an embodiment, but rather includesembodiments wherein components of multiple complex impedances are usedin the calculation of the value.

In an exemplary embodiment, the ECU 34 comprises a programmablemicroprocessor or microcontroller, but may alternatively comprise anapplication specific integrated circuit (ASIC). The ECU 34 may include acentral processing unit (CPU) and an input/output (I/O) interfacethrough which the ECU 34 may receive a plurality of input signalsincluding, for example and without limitation, signals from the compleximpedance sensor 64 of the tissue sensing circuit 28 (for themagnitude(s) of the complex impedance component(s)), the ablationgenerator 26 or another recording system in communication with theablation generator 26 (for the power level and/or the magnitude of theaverage power), and the temperature-sensing electrode or temperaturesensor disposed at or near the distal end 50 of the catheter 18 eitherdirectly or through the ablation generator 26. The ECU 34 may furthergenerate a plurality of output signals including those used to controlthe display device 36.

In accordance with one aspect of the present disclosure, the ECU 34 maybe programmed with a computer program (i.e., software) encoded on acomputer-readable storage medium for assessing the formation of a lesionin the tissue 12. More particularly, the computer program may beconfigured to assess the depth of a lesion being formed in the tissue 12(e.g., predicting the depth of the lesion or determining the likelihoodthe lesion has reached a predetermined depth) and/or the temperature ofthe tissue 12 as a result of an ablation procedure being performedthereon. As illustrated in FIG. 4, and generally speaking, the programincludes code for calculating a value responsive to magnitudes of one ormore components of the complex impedance between the electrode 16 andthe tissue 12, and the magnitude of the power or energy applied to thetissue 12 through the electrode 16, with the value being indicative ofone of, for example, a predicted depth of a lesion formed in the tissue,a likelihood that the lesion has reached a predetermined depth, and atemperature of the tissue 12 in which the lesion is being formed. Theprogram further includes code for performing or carrying out some or allof the functionality of the ECU 34 described in greater detail below.

Experimentation and analysis were performed to determine one or moreequations based, at least in part, on complex impedance that could beused by the ECU 34 to assess the formation of a lesion being formed inthe tissue 12 during an ablation procedure being performed thereon(i.e., an equation used to calculate a value that is indicative of apredicted depth of a lesion being formed in the tissue 12, a likelihoodof the lesion having reached a predetermined depth, or a predictedtemperature of the tissue 12 a predetermined depth below the surface ofthe tissue). Using controlled experimentation and one or both ofmultiple linear regression and binary logistic regression modelsperformed using software sold under the registered trademark “MINITAB”by Minitab, Inc., algorithms for predicting lesion depth, determiningthe likelihood that the lesion has reached a predetermined depth(predicting whether a lesion has reached a predetermined depth), andpredicting the temperature of the tissue at a given depth below thetissue surface were derived corresponding to the particular equipmentand arrangement of the system 10 used in the experimentation andanalysis, each of which will be described separately below. Factors thatwere evaluated in the testing and analysis for one or all of thealgorithms included, but were not necessarily limited to: the magnitudeof the instantaneous RF power applied to the tissue during lesionformation; the natural log of the applied power; the average powerapplied during the lesion formation process; the natural log of theaverage power applied during lesion formation; the duration of thelesion formation process; the natural log of the duration of the lesionformation process; the magnitude of the phase angle (φ) prior to theonset of lesion formation in the tissue; the pre-ablation magnitude ofthe phase angle (φ) both prior to and following contact between thecatheter 18 and the tissue 12; the magnitude of the resistance (R),reactance (X), and impedance (Z) following lesion formation; the changesin R, X, and φ from the onset of lesion formation (i.e., just after theapplication of RF power) to the end of lesion formation, or to a pointin time subsequent to the start of lesion formation and prior to the endof lesion formation; the magnitude of an electrical coupling index (ECI)of the tissue; the magnitude of the change in ECI from the onset oflesion formation to the end of lesion formation; the electrical current(I); and the catheter temperature (T). Regression models including someor all of the factors were created first, and then certain factors wereeliminated. After the elimination of a factor, the models were re-run,and the process was repeated.

With respect to the lesion depth prediction algorithm, once this processwas completed, it was generally determined that for predicting the depthof a lesion formed in the tissue 12 using the particular equipment andarrangement of the system 10 used in the experimentation and analysis(as opposed to, for example, predicting the temperature of the tissue,which will be described in greater detail below), the resistance (R) andphase angle (φ) components of the complex impedance between theelectrode 16 and the tissue 12; the average power applied to the tissue12; and the duration of the lesion formation process, or change in timefrom the start of the lesion formation process to the point in time thelesion depth is assessed, were preferred factors to be considered in thealgorithm. More specifically, it was determined that the natural log ofthe average power applied to the tissue during the lesion formationprocess; the change in time between the start of the lesion formationprocess and the point in time during or after the lesion formationprocess at which the predicted depth is calculated (dt); the phase angleprior to the onset of the lesion formation process (pre-ablation φ); thechange in resistance (dR) and phase angle (dφ) from the start of theformation of a lesion (i.e., just after the application of RF power tothe tissue 12) to the end of the lesion formation process, or at least asubsequent point in time in the formation process of the same lesion atwhich the predicted lesion depth is calculated, were the mostsignificant factors to be considered in the context of the equipmentused for testing.

It was further determined that various other factors would possibly havean impact on the accuracy of the prediction algorithm. These factorsinclude, for example and without limitation, certain parameters and/orcharacteristics of the equipment and/or arrangement of the system 10(such as, for example, the type of catheter and ablation generator beingused, the irrigation flow rate, etc.).

Accordingly, it was determined that the most computationally efficientalgorithm would be based on the “electrical” factors above (i.e.,resistance, phase angle, power magnitudes, etc.), as well as certainpredetermined coefficients and constants to account for designparameters or characteristics of the devices/equipment used in theablation procedure. More specifically, it was determined that the bestequation or algorithm was the equation (3):Predicted Depth=a+b ₁(ln Avg·P)+b ₂(dt)+b ₃(pre-ablation φ)+b ₄(dR)+b₅(dφ)  (3)

In this equation, the constant a and the coefficients b₁-b₅ arepredetermined values that are intended to account for the variousfactors associated with, for example, the equipment used in the ablationprocedure (i.e., type of catheter and/or ablation generator, irrigationflow rate, etc.). The constant and coefficients, which may be positiveor negative values depending on the circumstances, can be determined ina number of ways, such as, for example, controlled experimentation orusing analyses, such as, for example, a regression analysis. Once theconstant and coefficients are determined, they may be stored orprogrammed into the ECU 34, or a memory/storage device 73 (best shown inFIG. 1) associated therewith or accessible thereby. Alternatively, thecatheter 18 may itself include a memory such as an EEPROM that storesnumerical values for the coefficients/constant corresponding to thatparticular type of catheter and/or other equipment of the system 10, orstores a memory address for accessing the numerical values in anothermemory location. The ECU 34 may retrieve these values or addressesdirectly or indirectly and factor them into the calculation accordingly.

It should be understood that while the coefficients and constant of theparticular equation above may vary depending on, among other things, thespecific catheter used, the ablation generator employed, the irrigationflow rate, potentially the patient, other equipment in the system, thespecies being treated, and the like, the value calculated using theparticular equation above will always be responsive to components of thecomplex impedance and the RF power applied to the tissue in order toarrive at an optimal assessment of the predicted lesion depth in thetissue 12 during an ablation procedure performed thereon.

By way of example and illustration, employing the experimental testingand regression analysis described above, and using a RF ablationcatheter available from St. Jude Medical, Inc. under the name “GEN3” anda 485 kHz RF ablation generator, the best prediction of lesion depth fora system employing those particular components was determined to be thefollowing equation (4):Predicted Depth=−12.1+1.92(ln Avg·P)+1.94(dt)−0.454(pre-ablationφ)+0.0450(dR)+0.384(dφ)  (4)

This was determined by bench and/or animal testing that included testingon bovine myocardium, in-vivo testing in swine thighs, and in-vivotesting in the cardiac surfaces of swine. Data was collected and aregression model was performed to come to equation (4), and the valuesof the constant and coefficients thereof. With reference to FIG. 5, itwas determined through testing that the algorithm represented byequation (4) accounted for 80% of the variability observed in lesiondepth (i.e., R²=0.80).

As briefly described above, the particular equipment being used impactsthe form and composition of the lesion depth prediction algorithm. Forexample, using equipment different than that which was used to deriveequations (3) and (4) above, it was determined that for the particularequipment used, the most computationally efficient algorithm would bebased on the duration of the lesion formation process and the“electrical” factors of resistance (R), electrical current (I), andreactance (X), as well as certain predetermined coefficients andconstants to account for design parameters or characteristics of thedevices/equipment used in the ablation procedure. More specifically, itwas determined that the natural log of the change in time between thestart of the lesion formation process and the point in time during orafter the lesion formation process at which the predicted depth iscalculated (dt); the change in resistance (dR) and reactance (dX) fromthe start of the formation of a lesion (i.e., just after the applicationof RF power to the tissue 12) to the end of the lesion formationprocess, or at least a subsequent point in time in the formation processof the same lesion at which the predicted lesion depth is calculated,and an electrical current value calculated by taking the square root ofthe quotient of the division of the average power applied to the tissue12 during the lesion formation process by the value of the resistance(R) between the electrode 16 and the tissue 12 just after the start ofthe lesion formation process

$\left( {{i.e.},\sqrt{\frac{{Avg}.P}{R}}} \right)$were the most significant factors to be considered in the algorithm.

As with equation (3) above, it was further determined that various otherfactors would possibly have an impact on the accuracy of the predictionalgorithm. These factors include, for example and without limitation,certain parameters and/or characteristics of the equipment and/orarrangement of the system 10 (such as, for example, the type of catheterand ablation generator being used, the irrigation flow rate, etc.).

Accordingly, it was determined that the most computationally efficientalgorithm would be based on the “electrical” factors above (i.e.,resistance, reactance, electrical current, etc.), as well as certainpredetermined coefficients and constants to account for designparameters or characteristics of the devices/equipment used in theablation procedure. More specifically, it was determined that the bestequation or algorithm was the equation (5):Predicted Depth=a+b ₁(ln dt)+b ₂(dR)+b ₃ I+b ₄(dX)  (5)

As with equation (3) above, in this equation, the constant a and thecoefficients b₁-b₄ are predetermined values that are intended to accountfor the various factors associated with, for example, the equipment usedin the ablation procedure (i.e., type of catheter and/or ablationgenerator, irrigation flow rate, etc.). The constant and coefficients,which may be positive or negative values depending on the circumstances,can be determined in a number of ways, such as, for example, controlledexperimentation or using analyses, such as, for example, a regressionanalysis. Once the constant and coefficients are determined, they may bestored or programmed into the ECU 34, or a memory/storage device 73(best shown in FIG. 1) associated therewith or accessible thereby.Alternatively, the catheter 18 may itself include a memory such as anEEPROM that stores numerical values for the coefficients/constantcorresponding to that particular type of catheter and/or other equipmentof the system 10, or stores a memory address for accessing the numericalvalues in another memory location. The ECU 34 may retrieve these valuesor addresses directly or indirectly and factor them into the calculationaccordingly.

It should be understood that while the coefficients and constant of theparticular equation above may vary depending on, among other things, thespecific catheter used, the ablation generator employed, the irrigationflow rate, potentially the patient, other equipment in the system, thespecies being treated, and the like, the value calculated using theparticular equation above will always be responsive to components of thecomplex impedance and the RF power applied to the tissue in order toarrive at an optimal assessment of the lesion depth in the tissue 12during an ablation procedure performed thereon. It should be furthernoted that the constant and coefficients are determined and programmedas part of the manufacturing and/or setup process of the system 10, andthus, are not determined during the use of the system 10 in accordancewith its intended purpose.

By way of example and illustration, employing the experimental testingand regression analysis described above, and using a RF ablationcatheter available from St. Jude Medical, Inc. under the name “CoolPath” and a 485 kHz RF ablation generator, the best prediction of lesiondepth for a system employing those particular components was determinedto be the following equation (6):Predicted Depth=−5.03+1.07(ln dt)+0.0721(dR)+7.06I+0.205(dX)  (6)

Regardless of the particular equation or algorithm employed, oncecalculated, the predicted lesion depth may be used or displayed in anumber of ways, as will be described in greater detail below. In view ofthe foregoing, it will be appreciated that while the specificcomposition or constituent components of the lesion depth predictionalgorithm may change, the components of the complex impedance and themagnitude of the power applied during lesion formation are stilldeterminative factors in predicting lesion depth.

It should be noted that although the equations above and thecorresponding description above and below focus on the resistance (R),reactance (X), and phase angle (φ) complex impedance components, itshould be understood that the magnitude of impedance (|Z|) may beconsidered, or indeed any combination of the foregoing components of thecomplex impedance and derivatives or functional equivalents thereof, maybe used in assessing lesion depth. For example, in addition to thevalues of the constant and coefficients of the predicted lesion depthequation above changing due to factors such as the type of catheter, thetype of ablation generator, and other characteristics or parameters,these factors may also determine or impact which component or componentsof the complex impedance and/or aspects of the power are the mostsignificant, and therefore, best for use in the equation for calculatingthe predicted lesion depth for lesion formation processes using certainequipment.

Further, while the equations set forth above are based on two componentsof the complex impedance (i.e., R and φ or R and X), in other exemplaryembodiments the equation may be based on a single component, or morethan two components of the complex impedance, and may include more orless terms than equations (3)-(6) above. Therefore, the presentdisclosure is not meant to be limited to the use of any particularcomplex impedance components, particular aspects of the RF power, ornumber of components. Rather, any equation used to calculate thepredicted depth that is based on one or more components of one or morecomplex impedances, and one or more aspects of the power applied to thetissue 12 (e.g., average power, instantaneous power, etc.), remainwithin the spirit and scope of the present invention.

Once the particular complex impedance components to be used in thealgorithm for a particular catheter or arrangement of the system 10 aredetermined and the form of the algorithm/equation is resolved, thecomponents of the complex impedance (or an indication correspondingthereto), the equation to be used, and/or the specific terms of theequation (including, if appropriate, the constant(s) and/or coefficientsfor the equation terms) may be stored or programmed into the ECU 34, ora memory/storage device 73 (best shown in FIG. 1) associated therewithor accessible thereby. Alternatively, as described above, the catheter18 or another component in the system 10 may include a memory, such asan EEPROM, that is configured to store the above identified informationor a memory address for accessing the information stored in anothermemory location corresponding to that particular type of catheter and/orother equipment of the system 10. The ECU 34 may retrieve thisinformation or addresses directly or indirectly and use it in theaforedescribed calculation.

With reference to FIG. 6, an exemplary lesion depth predictioncalculation will be described. For purposes of clarity, brevity, andillustration, the description below has been limited to an embodimentwherein the lesion depth is calculated based using the equation (3)above. It will be appreciated in view of the above, however, that thepresent disclosure is not meant to be limited to such an embodiment.

As an initial matter, in addition to being configured to calculate thepredicted lesion depth described above, in an exemplary embodiment theECU 34 is also configured to acquire and/or calculate the terms used inthe equation for making the calculation (i.e., average power,pre-ablation φ, dt, dR, dφ, etc.). As described above, and asillustrated in FIG. 4, in this embodiment, the ECU 34 is configured toacquire magnitudes for the first and second components of the compleximpedance (i.e., R and φ), the magnitude of power being applied to thetissue 12 during the lesion formation process (and, in this example, themagnitude of the average power applied, in particular), and the elapsedtime of the lesion formation process. More particularly, with referenceto FIG. 6, the ECU 34 is configured to acquire a magnitude for thepre-ablation phase angle φ₀ between the electrode and tissue 12 at apoint in time t=t₀ prior to the commencement of the lesion formationprocess. The ECU 34 is further configured to acquire magnitudes for theresistance R₁ and phase angle φ₁ between the electrode 16 and the tissue12 at a point in time t=t₁ at which the lesion formation processcommences (i.e., just after initiation of RF power/energy delivery tothe tissue 12). These values may be received from the complex impedancesensor 64, and may be correlated and/or stored along with thecorresponding time (i.e., time t=t₁) in a temporary or permanent memoryor storage medium that is either part of, or accessible by, the ECU 34,such as, for example, the memory 73.

The ECU 34 is further configured to acquire magnitudes for R and φ at apoint in time t=t₂ at which the depth of a lesion formed or being formedis assessed (R₂, φ₂), and the average RF power (Avg.P) applied to thetissue 12 from the start of the lesion formation process (i.e., timet=t₁) to when the lesion depth is assessed (i.e., time t=t₂). The R andφ magnitudes may be received from the complex impedance sensor 64, andthe average power magnitude may be received from the ablation generator26, a reporting system associated therewith, or may be calculated by theECU 34. Each magnitude may then be correlated and/or stored along withthe corresponding time (i.e., time t=t₂) in a memory or storage devicesuch as that described above in the manner, for example, illustrated inFIG. 7.

Because the depth of a lesion may be assessed as it is being formed suchthat the lesion depth may be monitored in real-time, the ECU 34 isfurther configured to sample the magnitudes for R, φ, and Avg.Pthroughout the formation of the lesion at one or more respectivepredetermined sampling rates in order to constantly and continuouslymonitor the predicted depth of the lesion. In an exemplary embodiment, asampling rate on the order of 100 to 800 times per second may be used,however, the present disclosure is not meant to be limited to such arange of rates but rather a sampling rate that is greater than or lessthan 100 to 800 Hz may be used in different embodiments. Accordingly,the ECU 34 is configured to sample the signal received from the compleximpedance sensor 64 at a predetermined rate and to store thecorresponding R and φ values (R₁, R₂, . . . , R_(n) and φ₂, φ₂, . . .,φ_(n)) derived therefrom in the memory or storage medium describedabove along with the corresponding times (i.e., t_(n)) at which thesamples were taken (See FIG. 7). Similarly, the ECU 34 is configured tosample the signal received from the ablation generator 26, or anassociated reporting system, at a predetermined rate and to store thecorresponding power magnitudes and/or the magnitude of the average power(Avg.P₁, Avg.P₂, . . . , Avg.P_(n)) in a memory such as that describedabove along with the corresponding times (i.e., t₁, t₂, . . . , t_(n))at which the samples were taken (See FIG. 7). As briefly describedabove, in an exemplary embodiment, rather than the ablation generator 26providing the magnitude of the average power applied, the ECU 34 may beconfigured to receive signals from the ablation generator 26corresponding to the magnitude of the instantaneous power (P), and theECU 34 may be configured to make the calculation to determine theaverage power (Avg.P) based on current and past power magnitudes.

In an exemplary embodiment, after a set of samples of R, φ, and Avg.P istaken or acquired, the system 10 is configured to calculate thepredicted lesion depth described above. Alternatively, rather thancalculating the predicted depth after each set of samples, the ECU 34may be configured to calculate the predicted depth at some other rate,such as after a certain number of sets of samples have been collected,after a certain amount of time has elapsed, upon receiving instructionsfrom the user to do so, or after the lesion formation process has beencompleted. For the purposes of clarity and brevity alone, thedescription below will be directed to an embodiment wherein thepredicted depth is calculated after a set of samples of each of the R,φ, and Avg.P is collected at a particular point in time (i.e., timet=t₂). It will be appreciated, however that the present invention is notmeant to be limited to such an embodiment.

Accordingly, after a set of samples of each of R, φ, and Avg.P arecollected, the ECU 34 is configured to perform a number of calculations.For example, and as illustrated in FIG. 6, the ECU 34 is configured tocalculate a change in the resistance (dR) (Step 110), a change in thetime (i.e., the elapsed time) represented by the time interval from thepoint in time that the lesion formation process commenced to the pointin time that the current sample was taken (dt) (Step 112), a change inthe phase angle (dφ) (Step 114), and the natural log of the magnitude ofthe average power (Avg.P) applied to the tissue during the lesionformation process (Step 116).

With respect to the change in resistance, the ECU 34 is configured tocalculate the change in resistance over the time interval beginning atthe point in time at which the lesion formation process commences (i.e.,just after initiation of RF power/energy delivery to the tissue 12)(time t=t₁), to the point in the time corresponding to the currentresistance value (time t=t₂). Therefore, with reference to FIG. 6, ifthe predicted depth is being calculated using the values sampled at timet=t₂, the change in resistance is calculated by subtracting theresistance R₂ from the resistance R₁. Accordingly, the ECU 34 isconfigured to acquire resistance values R₁ and R₂ and to perform thecalculation to determine the change in resistance. Similarly, if theindex is being calculated at time t=t₃, the change in resistance iscalculated by subtracting the resistance R₃ from the resistance R₁, andso on and so forth. Accordingly, regardless of the point in time of thelesion formation process at which the predicted depth is beingcalculated, the current resistance value is processed with resistancevalue R₁ to determine the change in resistance (dR).

With respect to the change in time, the ECU 34 is configured tocalculate the change in time or the elapsed time represented by the timeinterval from the point in time that the lesion formation processcommenced (time t=t₁) to the point in time that the current samples weretaken, and therefore, the point in time that the predicted depth isbeing calculated. Accordingly, if the predicted depth is beingcalculated using the values sampled at time t=t₂, the change in time iscalculated by subtracting the time t₁ from the time t₂ to determine theelapsed time of the procedure thus far. Accordingly, the ECU 34 isconfigured to acquire the times corresponding to t₁ and t₂ and toperform the calculation to determine the change in time or the amount ofelapsed time. Similarly, if the predicted depth is being calculated attime t₃, the change in time is calculated by subtracting the time t₁from the time t₃, and so on and so forth. Accordingly, regardless of thepoint in time of the lesion formation process at which the predicteddepth is being calculated, the current time value is always processedwith the time value t₁ to determine the change in time (dt).

With respect to the change in phase angle, the ECU 34 is configured tocalculate the change in phase angle over the time interval beginning atthe point in time at which the lesion formation process commences (i.e.,just after RF power is applied to the tissue 12) (time t=t₁), to thepoint in the time corresponding to the current phase angle magnitude.Therefore, if the predicted depth is being calculated using themagnitudes sampled at time t=t₂, the change in phase angle is calculatedby subtracting the phase angle φ₂ from the phase angle φ₁. Accordingly,the ECU 34 is configured to acquire phase angle magnitudes φ₁ and φ₂ andto perform the calculation to determine the change in phase angle.Similarly, if the predicted depth is being calculated at time t=t₃, thechange in phase angle is calculated by subtracting the phase angle φ₃from the phase angle φ₁, and so on and so forth. Accordingly, regardlessof the point in time of the lesion formation process at which thepredicted lesion depth is being calculated, the current phase anglemagnitude is processed with phase angle magnitude φ₁ to determine thechange in phase angle (dφ).

Once all of the terms above are calculated, the ECU 34 is configured andable to calculate the predicted depth of the lesion at that point intime (Step 117). Accordingly, using equation (3) above as an example,the ECU 34 is configured to acquire the correct or appropriate valuesfor the constant a and the coefficients b₁-b₅, and to process thesevalues with the terms described above to come to a predicted lesiondepth. Accordingly, the computer program stored or accessible by the ECU34 includes code for carrying out the execution of the predicted depthequation. Once the predicted lesion depth is calculated, it may be usedin a number of ways.

In an exemplary embodiment, once the predicted lesion depth iscalculated, it may be displayed (Step 118) in visual form for the userof the system 10 to see. In one exemplary embodiment illustrated, forexample, in FIG. 8a , the predicted lesion depth may be displayed innumerical form (e.g., a digital readout) on the display 36 of thevisualization, mapping, and navigation system 32. The display 36 may beprovided to present information regarding the predicted lesion depth ina format useful to the user (e.g., clinician) of the system 10. By usingthe display 36 of the visualization, mapping, and navigation system 32,information regarding the predicted lesion depth may be displayed andcommunicated to the user (i.e., physician or clinician using the system10) in a concise, succinct, and easily understandable format. Moreover,by using the display 36 of the visualization, mapping, and navigationsystem 32, the number of monitors and/or amount of equipment isminimized and the user (i.e., physician or clinician using the system10) is not defocused from the information provided by the visualization,mapping, and navigation system 32, such as catheter manipulation andplacement in the cardiac anatomy. In an embodiment of the invention, theinformation regarding the predicted lesion depth may be displayed andcommunicated as an inset and/or sub window on the display device 36 ofthe visualization, mapping, and navigation system 32. Although thedisplay 36 of the visualization, mapping, and navigation system 32 maybe used to display information regarding the predicted lesion depth,other display devices may be used in accordance with other embodimentsof the system 10. For example and without limitation, the display devicemay comprise a separate LCD monitor or any other conventional displaydevice known to those of ordinary skill in the art.

This embodiment in which information regarding the predicted lesiondepth is displayed provides the user (i.e., physician or clinician usingthe system 10) with a real-time indication of lesion depth. Inparticular, the ECU 34 of the system 10 may receive a plurality of inputsignals for a time period. The system 10 may be configured to displayinformation regarding the predicted lesion depth based on the inputsignals for the time period during the time period, so as to providereal-time information regarding lesion depth. Accordingly, if the ECUcalculates the predicted lesion depth to be 4 mm, a reading of “4 mm”will be displayed on the display 36. Additionally, as illustrated inFIG. 8b , in an exemplary embodiment, the current calculated predictedlesion depth may be displayed along with a log of previously calculatedpredicted depths so as to provide the user of the system 10 with ahistory of calculated depths. For example, each of the previouslycalculated predicted lesion depths may be stored along with thecorresponding time (i.e, t₂, t₃, . . . , t_(n)) in a temporary orpermanent memory or storage medium that is either part of, or accessibleby, the ECU 34, such as, for example, the memory 73. The ECU 34 may thenbe configured to retrieve one or more of the previously calculatedpredicted lesion depths for display on the display 36.

In another exemplary embodiment illustrated, for example, in FIG. 8c ,the numeric representation of the calculated predicted lesion depth maybe displayed on a display, such as, for example, the display 36, alongwith a visual representation 74 indicative of the calculated predictedlesion depth. Although FIG. 8c includes both the numeric representationof the calculated predicted lesion depth along with the visualrepresentation 74, only the visual representation 74 may be displayed inaccordance with other embodiments of the system 10. As illustrated inFIG. 8c , the visual representation 74 may comprise a graph. Although abar graph is illustrated in detail, the visual representation 74 maycomprise any number of other visual representations. The visualrepresentation 74 may be configured to provide a visual indication as towhere the predicted depth falls within a spectrum of one or morepredetermined targets or thresholds. For example, in one exemplaryembodiment, the system 10 may be preprogrammed with one or morepredetermined depth targets or thresholds to which the predicted depthis compared. Alternatively, the user of the system 10 may set or adjustthese targets. For example, one predetermined depth target or thresholdto which the predicted depth may be compared is the thickness of thetarget tissue. The thickness of the target tissue may be obtained usingany number of techniques and methods known to those of ordinary skill inthe art. For example, tissue thickness of the target tissue may beobtained using imaging techniques, such as magnetic resonance imaging(MRI), prior to the ablation procedure being performed on the targettissue. Tissue thickness of the target tissue may also be obtained usingintracardiac echocardiography (ICE) using, for example, A mode or B modeultrasonographic technology. For another example, tissue thickness ofthe target tissue may be estimated by a clinician based on previousexperience, published anatomical data, and the like. Although particularmethods for obtaining information regarding tissue thickness aredescribed in detail, there are a number of other methods to obtaintissue thickness known to those of ordinary skill in the art and any ofthese methods can be used in accordance with other embodiments of theinvention. The information regarding tissue thickness of the targettissue may be input into ECU 34 through the input interface of the ECU34. The input interface may comprise a keyboard and/or a graphicalpointing device, such as a mouse, in accordance with an embodiment ofthe invention. The input interface may thus be configured to allow auser (e.g., clinician) of the system 10 to input, set, and/or adjust theinformation regarding tissue thickness of the target tissue in the ECU34. In accordance with another embodiment of the system 10, the system32 for visualization, mapping, and navigation of internal bodystructures may include software configured to import images obtainedthrough MRI and/or computed tomography (CT). The software may comprisesoftware sold under the name EnSite Fusion™ and commercially availablefrom St. Jude Medical, Inc. It may be possible for information regardingtissue thickness of the target tissue to be input into ECU 34, forexample, by direct importation of the images obtained through MRI and/orCT using software or by a direct measurement method (e.g., using an ICEcatheter).

For each target/threshold, a color or some other indicator may beassigned. For example, if there are three targets, a first may be deemedto be an insufficient depth and be assigned the color green, a secondmay be deemed to be a sufficient or desired depth and be assigned thecolor yellow, and a third may be deemed to be an excessive depth and beassigned the color red. As a predicted depth is calculated, it may becompared to the predetermined thresholds/targets and then the visualrepresentation (e.g., graph) 74 may present the appropriate color.Accordingly, as the lesion formation process progresses, the graphchanges to illustrate where the current lesion is on the spectrum. In anembodiment, the information regarding the calculated predicted lesiondepth may be displayed in a visual representation 200 comprising three,vertically stacked, circular images 202, 204, 206 resembling a “stoplight” design in which a different color is displayed on the display 36in the corresponding circular image 202, 204, 206, depending upon thecalculated predicted lesion depth as generally illustrated in FIG. 8d .For example, the system 10 may be programmed with a first color (e.g.,red) associated with a first range of measurements for the calculatedpredicted lesion depth; a second color (e.g., yellow) associated with asecond range of measurements for the calculated predicted lesion depth;and a third color (e.g., green) associated with a third range ofmeasurements for the calculated predicted lesion depth. In otherembodiments, the user of the system 10 may set or adjust these colorsand/or ranges of measurements. The color associated with the calculatedpredicted lesion depth may then be displayed and/or illuminated on thedisplay 36 in the “stop light” design in one of the correspondingcircular images 202, 204, 206. Although three colors (i.e., red, yellow,and green) and vertically stacked, circular images are used inaccordance with a “stop light” design, the number of colors and thespecific colors, as well as the configuration of the design may vary inaccordance with other embodiments of the invention.

In another exemplary embodiment, an indicator needle displayed on thedisplay device 36 may be used to indicate the current status of thelesion relative to the spectrum. For example, as generally illustratedin FIG. 8e , a visual representation 208 may comprise an indicatorneedle 210 that may be movable along a scale 212. Scale 212 may includehash marks 214 corresponding to the calculated predicted lesion depth inaccordance with an embodiment of the invention. However, hash marks 214may be removed in other embodiments of the invention. Visualrepresentation 208 may generally resemble a “gas tank gauge.” In thisembodiment, the indicator needle 210 may read “empty” when the depth ofthe calculated predicted lesion is zero or low. As the depth of thecalculated predicted lesion increases, the indicator needle 210 may read“full.” The indicator needle 210 may read “full” once the depth of thecalculated predicted lesion depth substantially equals the tissuethickness of the target tissue in accordance with an embodiment of theinvention. The calculated predicted lesion depth may also be shown bythe scale 212 changing appearance, color, shape, and/or size inaccordance with various embodiments of the invention. Referring now toFIG. 8f , the visual representation 216 may comprise a scale 218 inwhich colors and/or shading 220 may be used to indicate the depth of thecalculated predicted lesion depth. Multiple colors and/or shading couldbe used in connection with scale 218 in accordance with otherembodiments of the invention, and again, the calculated predicted lesiondepth may also be shown by the scale 218 changing appearance, color,shape, and/or size in accordance with various embodiments of theinvention.

As described hereinabove, one predetermined depth target or threshold towhich the predicted depth may be compared is the thickness of the targettissue, which may be input into ECU 34 in any manner that is known tothose of ordinary skill in the art. In an exemplary embodiment of ascreen display, one possible format for presenting predicted lesiondepth is a visual representation 222 comprising a graph and/or meter224. The graph and/or meter 224 may be an expanding bar graph thatincreases in size as the predicted calculated depth of the lesionincreases. Although the graph and/or meter 224 is shown as an expandingrectangular bar graph in FIGS. 8g-8j , the graph and/or meter 224 may beany number of other shapes or formats in other embodiments of theinvention. For example, lesion progression could be more complex basedon the algorithm and/or methodology used in connection with system 10,and the graph and/or meter 224 could be, for example and withoutlimitation, ellipsoidal in shape. Although an ellipsoidal shape ismentioned in detail, the graph and/or meter 224 could be any number ofother shapes in accordance with other embodiments of the invention.

In accordance with an embodiment of the invention, the graph and/ormeter 224 may be overlaid on a visual representation 226 of the targettissue or anatomy. In particular, the visual representation 226 of thetarget tissue or anatomy may be indicative of the thickness of thetarget tissue (e.g., the visual representation 226 of the target tissuemay be thicker if the target tissue is thicker and the visualrepresentation 226 of the target tissue may be less thick if the targettissue is less thick). The graph and/or meter 224 may be overlaid on thevisual representation 226 of the target tissue and the length and/orsize of the graph and/or meter may expand over the visual representation226 of the target tissue as the calculated predicted depth of the lesionincreases. Accordingly, the visual representation 222 may indicate thecalculated predicted depth of the lesion relative to the thickness ofthe target tissue. Examples of display of lesion progression are shownin FIGS. 8g-8j . In particular, at time t₁, the graph and/or meter 224shows that the lesion is a smaller percentage of the thickness of thetarget tissue as represented by visual representation 226. At time t₂,the graph and/or meter 224′ shows that the lesion is a slightly largerpercentage of the thickness of the target tissue as represented byvisual representation 226. At time t₃, the graph and/or meter 224″ showsthat the lesion is an even slightly larger percentage of the thicknessof the target tissue as represented by visual representation 226. Attime t₄, the graph and/or meter 224′″ shows that the lesion depth issubstantially equal to the thickness of the target tissue as representedby visual representation 226. Thus, the lesion depth corresponds tosubstantially 100% of the thickness of the target tissue at time t₄.FIG. 8j thus presents a visual representation indicative of thetransmurality of the lesion.

In addition to the visual representation indicative of the transmuralityof the lesion as generally shown in FIG. 8j , there may be other visualindications of the transmurality of the lesion such as an alert orwarning message on the display 36 indicating, for example, the words“Transmural Lesion”, a light, a color change, blinking, any specializedimage, and/or any of numerous other visual indications known to those ofordinary skill in the art used to indicate the transmurality of thelesion in the target tissue. In addition to and/or instead of the visualrepresentation indicative of the transmurality of the lesion asgenerally shown in FIG. 8j (or other visual indications of thetransmurality of the lesion), there may also be at least one of anaudible indication (e.g., buzzer, alarm, audible message, etc.), atactile indication, and/or a vibrational indication of the transmuralityof the lesion. The audible indication, tactile indication, and/orvibrational indication may be used in connection with the catheter 18(e.g., handle 44) in order to provide feedback to the user (e.g.,clinician or physician) of the system 10.

As generally illustrated in FIGS. 8g-8j , the predicted lesion depth asa percentage of thickness of the target tissue may be displayed inconcert with a visual representation 228 indicative of catheter 18. Thevisual representation 228 indicative of catheter 18 may be proximate oneor both of the graph and/or meter 224 and the visual representation 226indicative of the thickness of the target tissue in accordance withembodiments of the invention.

Referring now to FIG. 8k , the visual representation 226 of the targettissue or anatomy and the visual representation 228 indicative ofcatheter 18 may be displayed in multiple views along different axes. Forexample, the visual representations 226, 228 may be displayed in a firstview 230 that is an axial view. The axial view may generally depict thevisual representations 226, 228 along a head-to-toe axis of a body.Moreover, the visual representations 226, 288 may be displayed in asecond view 232 that is a sagittal view. The sagittal view may generallydepict the visual representations 226, 228 along a left-right axis of abody. Multiple views along multiple axes may assist the user (e.g.,clinician or physician) with respect to maintaining the stability of thecatheter 18.

As illustrated in FIGS. 8a-8f and 8l-8m , the predicted lesion depthcalculation(s) may be displayed in concert with a model or image 75(e.g., 2D or 3D image/model) of the anatomical structure that is beingablated (e.g., the heart or a portion thereof), as well as a real-timerepresentation of the ablation catheter 18 on the model or image 75. Inan exemplary embodiment, both the representation of the catheter 18 andthe image/model 75 may be generated by, for example, the visualization,mapping, and navigation system 32. In another exemplary embodiment, eachmay be generated by separate and distinct systems that are configuredfor use in conjunction with each other.

Accordingly, in yet another exemplary embodiment illustrated, forexample, in FIG. 8/, in addition to, or instead of, displaying thecalculated predicted lesion depth on the display 36, the ECU 34, oranother component of the system 10, may be configured to superimpose oneor more markers 76 on the image/model 75 that are indicative of thepredicted lesion depth calculated for the corresponding location on theanatomical structure. In one exemplary embodiment these markers 76 maybe color coded such that a first color represents a lesion depth of afirst magnitude or within a predetermined range, a second colorrepresents a lesion depth of a second magnitude or within a secondpredetermined range, and so on. In another exemplary embodiment, ratherthan color coding the markers 76, different markers (e.g., differentshapes, sizes, etc.) are used to differentiate between differentpredicted depths or depth ranges.

By placing markers 76 on the image/model 75, a lesion depth map may becreated and presented to the user of the system 10 on the display 36 toevaluate the depth of the lesion(s) formed in the tissue 12. In order toplace the markers 76 in the correct location(s), the system 10 mustcorrelate each calculated predicted lesion depth with the location onthe anatomical structure at which the measurements corresponding to thecalculated predicted depth were taken.

One exemplary method by which this may be done is as described in U.S.Pat. No. 7,263,397 entitled “Method and Apparatus for CatheterNavigation and Location and Mapping in the Heart,” which wasincorporated by reference above. In general terms, however, an electricfield is generated in the area in which the tissue being ablated isdisposed. As the electrode 16 of the catheter 18 is moved along thetissue 12 within the electric field, the location of electrode 16 ismonitored by the system 32 and using various known algorithms, theposition of electrode 16 is determined and recorded by system 32 as alocation point 78. A location point may be determined for each locationat which a predicted depth calculation is made, and the location point78 and the corresponding depth calculation may be correlated togetherand stored in a memory, such as, for example, the memory 73. The ECU 34may then use the location point(s) 78 to superimpose a marker(s) 76 ontothe image/model 75 in the correct position(s) wherein each markercorresponds to, and is representative of, the calculated predicted depth(e.g., the marker may be of a predetermined color or take apredetermined form corresponding to the calculated predicted depth, forexample). It will be appreciated that while the description above islimited to an electric-field based location system, those of ordinaryskill in the art will appreciate that other systems, such as, forexample, magnetic field-based location systems, may be used, andtherefore, remain within the spirit and scope of the present disclosure.

In yet another exemplary embodiment illustrated, for example, in FIG. 8m, the ECU 34 may be configured to superimpose one or more markers 76corresponding to a lesion created by the application of RF energy usingsystem 10. The markers 76 may be superimposed on the image/model 75 forthe corresponding location on the anatomical structure. Each marker maybe numbered or otherwise identified (e.g., different shapes, sizes,etc.) so as to provide a unique marker for each lesion (i.e., todifferentiate between different lesions). The system 10 may beconfigured to store information regarding a particular lesion (e.g.,calculated predicted lesion depth, transmurality of the lesion, etc.)along with the number or other identifier for the lesion in a temporaryor permanent memory or storage medium that is either part of, oraccessible by, the ECU 34, such as, for example, the memory 73. Thesystem 10 may be further configured to correlate each lesion with itslocation on the anatomical structure at which the measurementscorresponding to the calculated predicted lesion depth were taken. Oneexemplary method by which this may be done is described in U.S. Pat. No.7,263,397 entitled “Method and Apparatus for Catheter Navigation andLocation and Mapping in the Heart,” which was incorporated by referenceand described above.

The ECU 34 may be further configured to retrieve one or more of thenumbers or other identifiers for the lesions, along with one or moreitems of information regarding the corresponding lesion (e.g.,calculated predicted lesion depth, transmurality of the lesion, etc.).The ECU may be further configured to display on the display 36 one ormore of the numbers or other identifiers for the lesions, along with oneor more items of information regarding the corresponding lesion.Although FIG. 8m generally illustrates a display including at least twoof the numbers or other identifiers for the lesions, along withinformation regarding the lesion, fewer or more lesions may bedisplayed. In addition, information regarding multiple lesions may bedisplayed sequentially, simultaneously, and/or in any other format orlayout in other embodiments of the invention. The system 10 may beconfigured to allow for the display of additional information regardinga lesion in other embodiments of the invention. The system 10 may beconfigured to allow for a user of the system 10 to select one or moreparticular lesions for which the user desires information to bedisplayed. Accordingly, the system 10 may be configured to retrieve anyinformation regarding one or more previously created lesions that hasbeen stored in the temporary or permanent memory or storage medium thatis either part of, or accessible by, the ECU 34, such as, for example,the memory 73. The system may be further configured to display theinformation on display 36. Accordingly, information regarding anypreviously created lesions may be recalled by the system 10 anddisplayed to the user at a later time.

In another exemplary embodiment illustrated, for example, in FIGS. 8n-9b, in addition to or instead of displaying the calculated predicted depthon the display 36 in numeric form, the calculated predicted depth may becompared to a predetermined target and then an indication may beprovided based on whether the calculated predicted depth meets, exceeds,or falls short of the target. More particularly, with reference to FIG.9a , in one exemplary embodiment, the system 10 may be programmed with atarget that corresponds to a maximum lesion depth. This target may bepreprogrammed into the system 10 during the manufacturing process, ormay be set by the user. Additionally, the target may be fixed or,alternatively, may be adjustable by the user of the system 10. In aninstance wherein the user can either program the target into the system10 and/or adjust the target, the system 10 may include a user interface80 (shown in FIG. 1), such as, for example, a touch screen, a keyboard,a keypad, a slider control, or some other user-controllable input devicethat is electrically connected to the ECU 34 to allow the user to adjustthe target.

Once the target is set (Step 120), as each predicted depth calculationis made, it is compared to the target (Step 122). Depending on whetherthe calculated predicted depth is above, at, or below the target, anindication may be provided to the user (Step 118). For example, if thecalculated depth is at or above the target, an indication in the form ofa visual indicator such as a light or a message may be displayed on, forexample, the display 36, and/or an audio alert in the form of a buzzer,alarm, audible message, or other similar indicator may be activated. Ifthe calculated depth is below the target, no indication may be provided,or an indication in the form of a visual indicator different from thatindicating the target has been met or exceeded, such as a light or amessage, may be displayed on, for example, the display 36, and/or anaudio alert in the form of a buzzer or other similar indicator may beactivated.

In another exemplary embodiment illustrated, for example, in FIGS. 8eand 9b , the system 10 may be configured to have more than one target.For example, the system 10 may have a first target that, as describedabove, corresponds to a maximum lesion depth, and a second target thatcorresponds to a minimum lesion depth. As described above, these targetsmay be preprogrammed into the system during manufacturing, or may be setby the user. Similarly, the targets may be adjustable or fixed. In theinstance where the user may set or adjust the targets, the descriptionabove relating to a user interface applies here with equal force.Additionally, the respective targets may be displayed on the display 36,or alternatively, may be stored in the system 10 and not displayed.

As described above, as each predicted depth calculation is made, it iscompared to both targets (Step 122). Depending on whether the calculatedpredicted depth is above, at, or below the two targets, one or more anindications may be provided to the user (e.g., lights, visual or audiomessages, audio alerts, etc.) (Step 118). For example, in one exemplaryembodiment, the system 10 includes two indicators corresponding to eachtarget—“less than maximum,” “greater than maximum,” “less than minimum,”and “greater than minimum.” Accordingly, as a predicted depthcalculation is made, it is compared to each target. In one embodiment,if the calculation falls below both the minimum and maximum targets, thedisplay will provide the indicators “less than minimum” and “less thanmaximum.” If the calculation falls between the two targets, the displaywill provide the indicators “greater than minimum” and “less thanmaximum.” Further, if the calculation is greater than the maximum, thedisplay will provide the indicators “greater than minimum” and “greaterthan maximum.” It will be appreciated that rather than the specificindicators described here, other indicators, such as those describedabove with respect to the embodiment having a single target, may beused, and therefore, remain within the spirit and scope of the presentdisclosure.

Regardless of how the calculated predicted depth is processed and/ordisplayed, once the predicted depth has been calculated and evaluatedfor a set of samples taken at a predetermined point in time, in anexemplary embodiment, the system 10 is configured to repeat theabove-described process for a set of subsequent samples taken at asubsequent point in time in accordance with a predetermined rate ofcalculating the predicted depth (i.e., for each set of samples taken forR, φ, and Avg.P; after a predetermined number of sets of samples aretaken; after predetermined amount of time has elapsed, etc.). Theprocess may be continuously repeated at a given rate until, for example,the lesion has been acceptably formed (i.e., the lesion has reached acertain depth), or the formation process has been otherwise stopped.

As described above, rather than predicting the depth of a lesion, theformation of a lesion may be assessed by determining the likelihood thatthe lesion has reached a predetermined depth, or in other words,predicting whether a lesion has reached or attained a predetermineddepth. The predetermined depth may be, for example but is not limitedto, a depth corresponding to the thickness of the target tissue. Basedon the experimentation and analysis described above, and a binarylogistic regression analysis, in particular, it was generally determinedthat for the particular equipment and arrangement of the system used inthe experimentation, and for a particular target depth (which, in thisexample, is 2 mm), the resistance (R) and reactance (X) components ofthe complex impedance between the electrode 16 and the tissue 12, theduration of the lesion formation process, or change in time from thestart of the lesion formation process to the point in time the depth isassessed, and the power applied to the tissue 12 during the lesionformation process were significant factors to be considered in thealgorithm. More specifically, it was determined that the ECI of thetissue 12 derived, for example, from the resistance and reactancecomponents of the complex impedance (R and X), the duration of thelesion formation process (dt), and the average power (Avg.P) applied tothe tissue during the lesion formation process were the most significantfactors to be considered.

The ECI of the tissue 12 may be calculated or derived as described inU.S. patent application Ser. No. 12/253,637 filed Oct. 17, 2008 andentitled “System and Method for Assessing Coupling Between an Electrodeand Tissue,” which is incorporated herein by reference in its entirety.Generally speaking, however, in an exemplary embodiment provided forillustrative purposes only, the ECI may be based on mean values of theresistance (R) and reactance (X), and more specifically, the equation:ECI=a*Rmean+b*Xmean+c. In one exemplary embodiment, this equation wasfurther resolved into the following equation: ECI=Rmean−5.1Xmean.Accordingly, using this equation, for example, the ECU 34 may calculatethe ECI of the tissue 12.

It was further determined that various other factors would possibly havean impact on the accuracy of the algorithm. These factors include, forexample and without limitation, parameters or characteristics of theequipment and/or arrangement of the system 10 (such as, for example, thetype of catheter and ablation generator being used, the irrigation flowrate, etc.), the target depth being assessed and to which the algorithmcorresponds, and the like. Accordingly, it was determined that the mostcomputationally efficient index would be based on the “electrical”factors above (i.e., Avg.P, dt, ECI), as well as certain predeterminedconstants and coefficients to account for design parameters orcharacteristics of the devices/equipment used in the procedure and forthe target depth. More specifically, it was determined that the bestequation or algorithm was the equation (7):Index(2 mm)=a+b ₁Avg·P+b ₂(lndt)+b ₃(dECI)  (7)

In this equation, the constant a and the coefficients b₁-b₃ arepredetermined values that are intended to account for the variousfactors described above. The constant and coefficients can be determinedin a number of ways, such as, for example, controlled experimentation orusing analyses, such as, for example, a regression analysis. Once theconstant and coefficients are determined, they may be stored orprogrammed into the ECU 34, or a memory storage device 73 (best shown inFIG. 1) associated therewith or accessible thereby. Alternatively, thecatheter 18 may itself include a memory such as an EEPROM that storesnumerical values for the coefficients and constant corresponding to thatparticular type of catheter and/or other equipment of the system 10, orstores a memory address for accessing the numerical values in anothermemory location. The ECU 34 may retrieve these values or addressesdirectly or indirectly and factor them into the calculation accordingly.It should be noted that in any of the aforementioned arrangements orconfigurations, the coefficient/constant values may also be correlatedor associated in the memory with the particular target depth to whichthey correspond. For example, if the coefficients/constant have beendetermined for a depth of 2 mm, then they may be stored such that thecoefficient/constant values are associated with a depth of 2 mm.Accordingly, as will be described in greater detail below, algorithmsand/or coefficient and constant values for different depths may bestored and accessed by the ECU 34.

It should be understood that while the coefficients and constant of theparticular equation above may vary depending on, among other things, thespecific catheter used, the ablation generator employed, the targetdepth, the irrigation flow rate, potentially the patient, otherequipment in the system, the species being treated, and the like, thevalue calculated using the particular equation above will always beresponsive to components of the complex impedance and the RF powerapplied to the tissue in order to arrive at an optimal assessment of thepredicted lesion depth in the tissue 12 during an ablation procedureperformed thereon. It should be further noted that the constant andcoefficients are determined and programmed as part of the manufacturingand/or setup process of the system 10, and thus, are not determinedduring the use of the system 10 in accordance with its intended purpose.

By way of example and illustration, employing the experimental testingand regression analysis described above, and using a RF ablationcatheter available from St. Jude Medical, Inc. under the name “CoolPath”and a 485 kHz RF ablation generator, the best algorithm for determiningthe likelihood of a lesion reaching a target depth of 2 mm for a systememploying those particular components was determined to be the followingequation (8):Index(2 mm)=−12.2+0.23Avg·P+1.94(lndt)+0.11(dECI)  (8)

This was determined by data collected for lesions created in vitro innon-perfused bovine cardiac tissue. Data was collected and a regressionmodel was performed to come to equation (8), and the values of theconstant and coefficients thereof. The solution to the equationrepresents the natural log of the odds that a lesion attained or reacheda target depth (i.e., 2 mm for this particular equation). As will bedescribed in greater detail below, in an exemplary embodiment, once thevalue or index is calculated, it is compared to a predeterminedthreshold. The user of the system 10 may then be provided with anindication as to the likelihood that the lesion has attained the targetdepth depending on whether the calculated value or “index” exceeds or isbelow the predetermined threshold. The threshold may be determined bytesting or other analyses.

It should be noted that although equations (7) and (8) and thecorresponding description above and below focus on the use of ECI, itshould be understood that the value or index could also be based (inaddition or alternatively) on values associated with the rectangularcoordinates of the complex impedance, the polar coordinates of impedancemagnitude (|Z|) and phase angle (φ), or indeed any combination of theforegoing components of the complex impedance, power, and derivatives orfunctional equivalents thereof. For example, in addition to the valuesof the constant and coefficients of the index equation above changingdue to factors such as the type of catheter, the type of ablationgenerator, the target depth, and other characteristics or parameters,these factors may also determine or impact which component or componentsof the complex impedance and/or aspects of the power are the mostsignificant, and therefore, best for use in the equation for calculatingthe value or index for certain equipment and/or target depths.

Further, while the equations set forth above are based on two componentsof the complex impedance (ECI=Rmean−5.1Xmean), in other exemplaryembodiments the equation may be based on a single component, or morethan two components of the complex impedance, and may include more orless terms than equations (7) and (8). Additionally, while the equations(7) and (8) include a term based on the magnitude of the average powerapplied to the tissue 12, in other embodiments one or more other aspectsof the RF power, such as, for example, the natural log of the RF power,the instantaneous power, and the like may be used in addition to orinstead of the average power magnitude. Therefore, it will beappreciated that the form of the equation to be used for calculating thevalue or index may be highly dependent on the type or types of theequipment used in the ablation procedure and the target depth.Therefore, the present invention is not meant to be limited to the useof any particular complex impedance components, particular aspects ofthe RF power, or number of components. Rather, equations used tocalculate the value or index that are based on one or more values or oneor more components of one or more complex impedances, and one or morevalues of aspects of the power applied to the tissue 12 remain withinthe spirit and scope of the present invention.

Once the particular complex impedance components to be used incalculating the value for a particular catheter or arrangement of thesystem 10 and for a particular depth are determined and the form of theequation is resolved, the components of the complex impedance (or anindication corresponding thereto), the equation to be used, and/or thespecific terms of the equation (including, if appropriate, theconstant(s) and/or coefficients for the equation terms) may be stored orprogrammed into the ECU 34, or a memory/storage device 73 (best shown inFIG. 1) associated therewith or accessible thereby. Alternatively, thecatheter 18 or another component in the system 10 may include a memory,such as an EEPROM, that is configured to store the above identifiedinformation or a memory address for accessing the information stored inanother memory location corresponding to that particular type ofcatheter and/or other equipment of the system 10. The ECU 34 mayretrieve this information or addresses directly or indirectly and use itto calculate the value or index. As will be described below, in anexemplary embodiment, the memory in which the equations are stored mayhave a number of equations stored therein. For example, differentequations for different catheters/equipment may be stored in the memory,as well as multiple equations for the same equipment but correspondingto different depths. Accordingly, depending on the equipment used and/orthe target depth being assessed, the ECU 34 may obtain or acquire thecorrect equation/algorithm.

With reference to FIG. 10, an exemplary calculation will be describedfor determining the likelihood that a lesion has reached a predetermineddepth will be described. For purposes of clarity, brevity, andillustration, the description below of an exemplary calculation has beenlimited to an embodiment wherein the value or index is calculated based,in part, on the ECI of the tissue 12, the magnitude of the average powerapplied to the tissue 12, and the magnitude of duration of the lesionformation process (i.e., using the equation (7) above). It has furtherbeen limited to an equation corresponding to a depth of 2 mm. It will beappreciated in view of the above, however, that the present disclosureis not meant to be limited to such an embodiment.

As an initial matter, in addition to being configured to calculate thevalue or index described above, in an exemplary embodiment, the ECU 34is also configured to acquire and/or calculate the terms used in theequation for calculating the value (i.e., Avg.P, dt, dECI, etc.). Asdescribed above, and as illustrated in FIG. 4, in this embodiment, theECU 34 is configured to acquire magnitudes for first and secondcomponents of the complex impedance (i.e., R and X), the magnitude ofpower being applied to the tissue 12 during the ablation procedure (andmore particularly, the magnitude of the average power applied), and theelapsed time of the lesion formation process. More particularly, withreference to FIG. 10, the ECU 34 is configured to acquire magnitudes forthe resistance R₁ and reactance X₁ between the electrode 16 and thetissue 12 at a point in time t=t₁ at which the lesion formation processcommenced (i.e., just after initiation of RF power/energy delivery tothe tissue 12), and to calculate an ECI (ECI₁) based on the magnitudesof R₁ and X₁ (Step 124). The magnitudes of R₁ and X₁ may be receivedfrom the complex impedance sensor 64, and may stored along with thecorresponding time (i.e., t=t₁) in a temporary or permanent memory orstorage medium that is either part of, or accessible by, the ECU 34,such as, for example, the memory 73.

The ECU 34 is further configured to acquire magnitudes for R and X at apoint in time t=t₂ at which the depth of a lesion formed or being formedis assessed (R₂ and X₂), and to calculate an ECI (ECI₂) based on themagnitudes of R₂ and X₂ (Step 126). The ECU 34 is still furtherconfigured to acquire the magnitude of the average RF power (Avg.P)applied to the tissue 12 from the start of the lesion formation process(i.e., time t=t₁) to when the lesion depth is assessed (i.e., time t=t₂)(Step 128). The R and X magnitudes may be received from the compleximpedance sensor 64, and the average power magnitude may be receivedfrom the ablation generator 26, a reporting system associated therewith,or may be calculated by the ECU 34. Each magnitude may be correlatedand/or stored along with the corresponding time (i.e., t=t₂) in a memoryor storage device, such as that described above, in the mannerillustrated, for example, in FIG. 11.

Because the depth of a lesion may be assessed as it is being formed suchthat the lesion depth may be monitored in real-time, the ECU is furtherconfigured to sample the magnitudes of R, X, and Avg.P throughout theformation of the lesion at one or more respective predetermined samplingrates in order to constantly and continuously monitor the formation ofthe lesion. In an exemplary embodiment, a sampling rate on the order of100 to 800 times per second may be used, however, the present disclosureis not meant to be limited to such a range of rates but rather samplingrates that are greater or less than 100 to 800 Hz may be used indifferent embodiments. Accordingly, the ECU 34 is configured to samplethe signal received from the complex impedance sensor 64 at apredetermined rate and to store the corresponding R and X values (R₁,R₂, . . . ,R_(n) and X₁, X₂, . . . ,X_(n)) derived therefrom in thememory or storage medium described above along with the correspondingtimes (i.e., t₁, t₂, . . . , t_(n)) at which the samples were taken (SeeFIG. 11). The ECU 34 is further configured to calculate an ECI for eachcorresponding R and X values, and to store each ECI in the memory orstorage medium as well, Similarly, the ECU 34 is configured to samplethe signal received from the ablation generator 26, or an associatedreporting system, at a predetermined rate and to store the correspondingaverage power magnitudes (Avg.P₁, Avg.P₂, . . . , P_(n)) in a memorysuch as that described above along with the corresponding times (i.e.,t₁, t₂, . . . , t_(n)) at which the samples were taken (See FIG. 11). Asbriefly described above, in an exemplary embodiment, rather than theablation generator 26 providing the magnitude of the average powerapplied, the ECU 34 may be configured to receive signals from theablation generator 26 corresponding to the magnitude of theinstantaneous power (P), and the ECU 34 may be configured to make thecalculation to determine the average power (Avg.P) based on current andpast power magnitudes.

In an exemplary embodiment, after each sample of R, X, and Avg.P istaken, and an ECI based on the R and X samples is calculated, the system10 is configured to calculate the value or index described above.Alternatively, rather than calculating the value or index after eachsample, the ECU 34 may be configured to perform the calculation at someother rate, such as after a certain number of samples have beencollected or after a certain amount of time has elapsed. For thepurposes of clarity and brevity alone, the description below will bedirected to an embodiment wherein the calculation is made after a sampleof each of the R, X, and Avg.P is collected at a particular point intime (i.e., time t=t₂). It will be appreciated, however that the presentdisclosure is not meant to be limited to such an embodiment.

Accordingly, after a set of samples of each of R, X, and Avg.P arecollected, and an ECI based on the values of R and X is calculated(Steps 124-128), the ECU 34 is configured to perform a number ofcalculations. For example, and as illustrated in FIG. 10, the ECU 34 isconfigured to calculate a change in the time, or the elapsed time,represented by the time interval from the point in time that the lesionformation process commenced to the point in time that the current samplewas taken (dt) (Step 130), and to calculate the natural log of themagnitude of the change in time (Step 132). The ECU 34 is furtherconfigured to calculate a change in ECI (dECI) of the tissue 12 betweenthe ECI of the tissue 12 at the onset of the lesion formation processand the ECI at the point in time at which the lesion depth is beingassessed (Step 134).

With respect to the change in time, the ECU 34 is configured tocalculate the change in time or the elapsed time represented by the timeinterval from the point in time that the lesion formation processcommenced (i.e., time t=t₁) to the point in time that the currentsamples were taken, and therefore, the point in time that the lesiondepth is being assessed. Accordingly, if the value or index is beingcalculated using the values sampled at time t=t₂, the change in time iscalculated by subtracting the time t₁ from the time t₂ to determine theelapsed time of the procedure thus far. Accordingly, the ECU 34 isconfigured to acquire the times corresponding to t₁ and t₂ and toperform the calculation to determine the magnitude of the change in timeor the amount of elapsed time. Similarly, if the value or index is beingcalculated at time t₃, the change in time is calculated by subtractingthe time t₁ from the time t₃, and so on and so forth. Accordingly,regardless of the point in time of the lesion formation process at whichthe index is being calculated, the current time value is alwaysprocessed with the time value t₁ to determine the change in time. Oncethe change in time magnitude is determined, the ECU 34 is configured tocalculate the natural log of the change in time magnitude (ln dt).

With respect to the change in ECI (dECI), the ECU 34 is configured tocalculate the change in the ECI over the time interval beginning at thepoint in time the lesion formation process commences (i.e., just afterinitiation of RF power/energy delivery to the tissue 12) (i.e., timet=t₁), to the point in time at which the lesion depth is assessed.Accordingly, if the calculation is being made for the samples of R, X,and Avg.P taken at time t=t₂, dECI is calculated by subtracting ECI₂from ECI₁. Accordingly, the ECU 34 is configured to calculate or acquireECI magnitudes ECI₁ and ECI₂ and to perform the calculation to determinethe change in ECI. Similarly, if the value or index is being calculatedat time t₃, the change in ECI is calculated by subtracting the ECI₃ fromthe ECI₁, and so on and so forth. Accordingly, regardless of the pointin time of the lesion formation process at which the value or index isbeing calculated, the current ECI magnitude is always processed with theECI₁ to determine the change in ECI.

Once all of the terms above are calculated, the ECU 34 is configured andable to calculate the value or index in order to determine thelikelihood that the lesion has reached or achieved a predetermined depth(i.e., 2 mm in this exemplary embodiment) or to predict whether thelesion has reached the predetermined depth (Step 136). Accordingly, theECU 34 is configured to acquire the correct or appropriate values forthe constant a and the coefficients b₁-b₃, and, using the appropriateequation, to process these values with the terms described above to cometo a value or index. Accordingly, the computer program stored oraccessible by the ECU 34 includes code for carrying out the execution ofthe equation. Once the value or index is calculated, it may be used in anumber of ways.

In an exemplary embodiment, such as that illustrated in FIG. 10, thesystem 10, and the ECU 34, in particular, is programmed with, orconfigured to access, a threshold value to which the index or valuecalculated by the equation is compared to determine or predict whetherthe lesion has achieved a certain depth. The threshold is determined byexperimentation and/or analysis performed prior to use of the system 10(i.e., as part of the manufacturing or set up process, for example), andmay be impacted by the factors described above, such as, for example,the type of catheter, the type of ablation generator, and othercharacteristics relating, for example, the equipment of the system 10.In such an embodiment, the calculated index or value is compared to thethreshold value (Step 138) and, based on that comparison, the ECU 34 isconfigured to generate a signal representative of a prediction that thelesion depth has exceeded or is greater than a predetermined depth(e.g., the index or value meets or exceeds the threshold), or that ispredicted that the lesion depth is less than the predetermined depth(e.g., the index or value does not meet and is below the threshold). TheECU 34 may be further configured to then control a display device, suchas, for example, the display 36, to display the prediction representedby the signal generated by the ECU 34 (Step 140).

In an exemplary embodiment, the threshold is set prior to the system 10being used and is not adjustable. Alternatively, in another exemplaryembodiment, the threshold may be adjustable by the user to change, forexample, the sensitivity of the system. In the latter embodiment, thesystem 10 may include a user interface, such as for example, user inputdevice 80, which may comprise a touch screen, a keyboard, a keypad, aslider control, or some other user-controllable input device that iselectrically connected to the ECU 34, to allow the user to adjust thethreshold value (Step 137).

More particularly, the system 10 may be programmed with multiplethreshold values corresponding to the same target depth, but thatrepresent varying levels of sensitivity. These threshold values may bestored in a memory associated with, or accessible by, the ECU 34 (e.g.,the sensitivity levels and corresponding threshold values may be storedin a look-up table, for example). In an exemplary embodiment providedfor illustrative purposes only, the system 10 may have three thresholdvalues that correspond to the target depth—one for high sensitivity, onefor medium sensitivity, and one for low sensitivity. In one exemplaryembodiment, the threshold for the medium sensitivity may be the defaultthreshold that is used unless the user adjusts the sensitivity of thesystem. In another exemplary embodiment, the user may have to set thedesired sensitivity when the system 10 is initialized. In anotherembodiment, rather than adjusting the sensitivity level of the system,and therefore, the threshold, the value of the threshold may beadjustable by the user inputting a value for the threshold, or otherwiseadjusting the threshold value (as opposed to indirectly adjusting thethreshold by adjusting the sensitivity). In any case, the user has ameasure of control over the sensitivity of the system 10.

In an exemplary embodiment, in addition to, or instead of, the thresholdbeing adjustable, the target depth may be adjusted. For example, whilethe description above has generally been with respect to a target depthof 2 mm, in an exemplary embodiment of the system 10, the user is ableto adjust the target depth using, for example, the user input device 80.In such an embodiment, the system 10, and the ECU 34, in particular, isconfigured to have a plurality of equations or algorithms stored thereinor in a memory accessible thereby, that correspond to different depths(e.g., in an exemplary embodiment, the depths and correspondingalgorithms may be stored in a look-up table that may be accessed by theECU 34). Alternatively, the catheter 18 may be configured to store thevarious equations or algorithms in the same manner described above.Accordingly, the user may input the desired target depth into the system10, and the ECU 34 is configured to obtain the corresponding algorithmand to perform the calculations and comparisons accordingly. FIG. 12illustrates and exemplary embodiment of a display 36 that includes ameans by which the target depth may be adjusted. Accordingly, the system10 is not limited to assessing the odds of a lesion reaching anyparticular depth, but rather may have the flexibility to assess morethan one depth.

In an exemplary embodiment, once the value or index is calculated and itis compared to the threshold value, the system 10 may be configured tocause an appropriate indicator to be given to the user of the system 10relating to the prediction of whether the target depth has been met. Theindicator generated by the ECU 34 may take many forms. For example, withreference to FIG. 12, the indicator may be displayed on the displaymonitor 36. Such a displayed indicator may include, for exemplarypurposes only, displaying an alert or warning message on the monitor 36.In the illustrated embodiment, an indicator may be provided as towhether the lesion depth is “less than” the target depth, or “greaterthan” the target depth. The indicator may also be in the form of alesion marker on a map of the target tissue. The lesion marker may varyin color and/or size depending on the nature of the lesion predicted,for example, a deep lesion may be red, a shallow lesion may be green,and an intermediate lesion may be yellow. The system may allow the userto set the ranges for particular colors. In another embodiment, thesystem may consider the tissue depth at a particular target location anduse a particular color marker color to indicate when the lesion is at adepth that is considered transmural for the target location. In otherexemplary embodiments, the indicator may take the form of an audiblealert, a visible indication on the catheter handle or another device ofthe system 10, haptic feedback, a binary type output (e.g., “lighton”/“light off”), a gas gauge type of output, or any other indicatorsdescribed above with respect to FIGS. 8a-8f , or as known in the art.Based on the indicator provided to the user, the user may takecorrective measures, such as, for example and without limitation, movingthe electrode 16 away from the tissue or toward a new tissue section,reducing the RF power being applied to tissue, and/or other the likemeasures.

In an exemplary embodiment, rather than assessing the depth of thelesion with respect to a single target depth, the system 10, and the ECU34, in particular, is configured to assess the depth of the lesion withrespect to multiple target depths. For example, a user may want to forma lesion in the tissue 12 that exceeds a minimum depth, but that is lessthan a maximum depth. A minimum depth may be set to maximize theefficacy of the ablation procedure, while the maximum depth may be setto maximize the safety of the ablation procedure. Accordingly, in suchan embodiment, the system 10 is configured to access or obtain thealgorithms (which are created or determined in the manner describedabove) corresponding to the minimum and maximum depths. In the samemanner described above wherein a single target depth is assessed, theECU 34 is further configured to calculate a value or index for eachalgorithm simultaneously. The resulting values or indices are thencompared to the respective thresholds, and, as illustrated in FIG. 13,corresponding indicators are provided to the user for each target depthin the same manner described above. It will be appreciated that thealgorithms may include the same or different terms (i.e., the algorithmsmay be derived from the same or different electrical characteristics orfactors and/or have the same or different number of terms), and may havethe same or different values for the constants and coefficients (i.e.,the same or different values and/or number of constants andcoefficients).

As with the single-target embodiment, in an exemplary embodiment, thesensitivity of the system may be adjusted in the same manner describedabove for each target depth. Additionally, each target depth may beadjusted in the same manner described above. Accordingly, the system 10is not limited to assessing the depth of a lesion with respect to asingle target depth, but rather may be used to assess multiple depths orranges of depths.

Whether one or more target depths are being assessed, once thecorresponding value(s) have been calculated and processed for a set ofsamples taken at a predetermined point in time, the process repeatsitself for a set of subsequent samples taken at a subsequent point intime in accordance with a predetermined rate of performing thecalculation (i.e., for each set of samples taken for R, X, and Avg.P;after a predetermined number of samples are taken; after predeterminedamount of time has elapsed, etc.). The process may be continuouslyrepeated at a given rate until, for example, the lesion has beenacceptably formed, or the formation process has been otherwise stopped.

As described above, rather than assessing the formation of a lesion bycalculating a predicted lesion depth in the tissue 12 resulting from anablation procedure being performed thereon, or by predicting whether thelesion has attained a predetermined depth, in another exemplaryembodiment, the temperature of the tissue as a result of an ablationprocedure may be predicted and then used, for example, to assess thedepth of the lesion.

Using the experimentation and analysis described above, it was generallydetermined that for predicting the temperature of the tissue 12 apredetermined depth below the surface (which, in this example, was 3 mm)using the particular equipment and arrangement of the system 10 used inthe experimentation and analysis, the reactance (X), the resistance (R),the impedance (Z), and the phase angle (φ) components of the compleximpedance between the electrode 16 and the tissue 12, the instantaneouspower applied to the tissue 12 (P) at the point in time for which thecalculation is made, the duration of the lesion formation process (dt),and the temperature of the tip of the catheter (T) were significantfactors to be considered in the algorithm. More specifically, it wasdetermined that the reactance (X), resistance (R), power (P), cathetertemperature (T), and impedance (Z) at the time of the calculation, theproduct of the power (P) and the duration (dt) of the lesion formationprocess, the pre-ablation change in the phase angle φ between when theelectrode 16 contacts the tissue 12 and prior to the electrode 16contacting the tissue (dφ) (i.e., when the electrode 16 is in thechamber but not in contact with the tissue, for example), the naturallog of the duration (dt), and the natural log of the instantaneous power(P) were the most significant factors to be considered.

As with the depth prediction algorithm described above, it was furtherdetermined that various other factors would possibly have an impact onthe accuracy of the temperature prediction algorithm. These factorsinclude, for example and without limitation, certain parameters and/orcharacteristics of the equipment and/or arrangement of the system 10(such as, for example, the type of catheter and ablation generator beingused, the irrigation flow rate, etc.), as well as the depth below thesurface (e.g., endocardial surface) of the tissue 12 for which thetemperature is being predicted. Accordingly, it was determined that forthe equipment used in the testing and for a depth of three millimeters(3 mm) below the tissue surface (which is provided for exemplarypurposes only) the most computationally efficient algorithm would bebased on the factors above (e.g., X, R, P, T, Z, dφ, dt, etc.), as wellas certain predetermined coefficients and constants to account fordesign parameters or characteristics of the devices/equipment used inthe ablation procedure, for example. More specifically, it wasdetermined that the best equation or algorithm was the equation (9):Predicted Temperature=a+b ₁ X+b ₂ R+b ₃ P+b ₄ T+b ₅ Z+b ₆(P*(dt))+b₇(dφ)+b ₈(lndt)+b ₉(lnP)  (9)

In this equation, the constant a and the coefficients b₁-b₉ arepredetermined values that are intended to account for the variousfactors associated with, for example, the equipment used in the ablationprocedure (i.e., type of catheter and/or ablation generator, irrigationflow rate, etc.). The constant and coefficients, which may be positiveor negative values depending on the circumstances, can be determined ina number of ways, such as, for example, controlled experimentation orusing analyses, such as, for example, a regression analysis. Once theconstant and coefficients are determined, they may be stored orprogrammed into the ECU 34, or a memory/storage device 73 (best shown inFIG. 1) associated therewith or accessible thereby. Alternatively, thecatheter 18 may itself include a memory such as an EEPROM that storesnumerical values for the coefficients/constant corresponding to thatparticular type of catheter and/or other equipment of the system 10, orstores a memory address for accessing the numerical values in anothermemory location. The ECU 34 may retrieve these values or addressesdirectly or indirectly and factor them into the calculation accordingly.

It should be understood that while the coefficients and constant of theparticular equation above may vary depending on, among other things, thespecific catheter used, the ablation generator employed, the irrigationflow rate, potentially the patient, other equipment in the system, thespecies being treated, the depth for which the temperature is beingpredicted, and the like, the value calculated using the particularequation above will always be responsive to components of the compleximpedance and the RF power applied to the tissue (e.g., instantaneouspower) in order to arrive at an optimal assessment of the predictedtemperature of the tissue 12 a predetermined depth below the surfacethereof. It should be further noted that the constant and coefficientsare determined and programmed as part of the manufacturing and/or setupprocess of the system 10, and thus, are not determined during the use ofthe system 10 in accordance with its intended purpose.

By way of example and illustration, employing the experimental testingand regression analysis described above, and using a RF ablationcatheter available from St. Jude Medical, Inc. under the name “CoolPath”and a 485 kHz RF ablation generator, the best prediction of thetemperature of the tissue three millimeters (3 mm) below the surface ofthe endocardial surface of the tissue 12 for a system employing thoseparticular components was determined to be the following equation (10):PredictedTemperature=−557−2.44X−1.37R−6.88P+3.05T+3.29Z+0.0377(P*(dt))+21.1(dφ)−14.1(lndt)+167(lnP)  (10)

As with the lesion depth prediction algorithm described above, this wasdetermined by bench and/or animal testing that included testing onbovine myocardium. Data was collected and a regression model wasperformed to come to equation (10), and the values of the constant andcoefficients thereof.

As set forth in equations (9) and (10), the temperature of the tip ofthe catheter 18 (T) and the pre-ablation phase angle both prior to andfollowing the electrode 16 contacting the tissue 12 are evaluated inpredicting the temperature of the tissue. Accordingly, the system 10must include components to both sense the temperature of the tip of thecatheter 18, and sense contact, or lack thereof, between the catheter 18and the tissue 12.

With respect to the temperature of the tip of the catheter 18 (T), in anexemplary embodiment the system 10 includes a temperature-sensingelectrode or temperature sensor disposed at the tip of the catheter 18.In one exemplary embodiment, the temperature sensor comprises athermocouple disposed at the distal end 50 of the catheter andconfigured to generate an electrical signal representative of thetemperature sensed at the tip of the catheter 18. Thetemperature-sensing electrode or temperature sensor is furtherconfigured to communicate the generated signal to the ECU 34 and/or theablation generator 26. In the latter instance, the ablation generator 26would be configured to report the temperature to the ECU 34.Accordingly, the ECU 34 and/or ablation generator 26 is electricallyconnected to the temperature-sensing electrode or temperature sensor(i.e., either by wire(s) or wirelessly) and is configured to receive theelectrical signal therefrom.

With respect to the sensing of contact between the catheter 18 and thetissue 12, any number of different contact sensing techniques may beused. For example, using a real-time image, such as a fluoroscopicimage, for example, a physician may be able to visualize when thecatheter 18 contacts the tissue 12. In another example, a real-timeimage may be used in conjunction with a physician's tactile sensing todetermine contact has been made. In either instance, when the physicianbelieves contact has been made, he may trigger the measurement of thephase angle between the electrode 16 and the tissue 12 by inputting acommand into a user interface, such as, for example, the user interface80 described above. Accordingly, the user input device 80 is configuredto generate signal in response to an input by the user.

In another exemplary embodiment, the catheter 18 may have a sensingelement (not shown) disposed at or near the tip thereof (i.e., at ornear the distal end 50 of the catheter 18) and electrically connectedto, for example, the ECU 34. The sensing element, which may comprise anelectrode or a sensor, for example, is configured and operative togenerate a signal indicative of contact between the sensing element andthe tissue 12. Exemplary methods of contact sensing are described inU.S. patent application Ser. No. 12/347,216, filed Dec. 31, 2008 andentitled “Multiple Shell Construction to Emulate Chamber Contractionwith a Mapping System,” incorporated herein by reference above. In oneexemplary embodiment, the sensing element may take the form of any oneor more of a variety of electrical-based, electro-mechanical-based,force-based, optically-based, as well as other technology-basedapproaches known in the art for determining when the sensing element isin contact with the surface of the tissue 12.

An alternate approach for sensing contact is to assess the degree ofelectrical coupling as expressed, for example, in an electrical couplingindex (ECI) between such a sensing element and the surface, as seen byreference to, for example, U.S. patent application Ser. No. 12/253,637,filed May 30, 2008 and entitled “System and Method for AssessingCoupling Between an Electrode and Tissue,” which is incorporated hereinby reference in its entirety.

In yet another alternate approach, an electrically-measured parameterindicative of contact, such as, for exemplary purposes only, the phaseangle of a measured complex impedance, may be used to determine when thesensing element is in contact with tissue 12. One phase anglemeasurement technique may be as described in U.S. Patent Publication No.2009/0171345 entitled “System and Method for Measurement of an ImpedanceUsing a Catheter such as an Ablation Catheter,” which is incorporatedherein by reference in its entirety.

Accordingly, the system 10 may employ one or more of the above-describedtechniques to sense when the catheter 18 has contacted the tissue 12 inorder to make the necessary measurements needed for the temperatureprediction algorithm.

It should be noted that although the equations above relating topredicting tissue temperature and the corresponding description aboveand below focus on the combination of the R, X, Z, and φ components ofthe complex impedance, it should be understood that, in addition oralternatively, combinations comprising less than all of the compleximpedance components, and derivatives or functional equivalents thereof,may be used in predicting tissue temperature. For example, in additionto the values of the constant and coefficients of the index equationabove changing due to factors such as the type of catheter, the type ofablation generator, and other characteristics or parameters, thesefactors may also determine or impact which component or components ofthe complex impedance and/or aspects of the power are the mostsignificant, and therefore, best for use in the equation for calculatingthe predicted tissue temperature at a certain depth below the surface ofthe tissue and using certain equipment. Therefore, the present inventionis not meant to be limited to the use of any particular compleximpedance components, particular aspects of the RF power, or number ofcomponents. Rather, equations used to calculate the predicted tissuetemperature that are based on one or more components of one or morecomplex impedances, and one or more aspects of the power applied to thetissue 12 remain within the spirit and scope of the present invention.

Once the particular complex impedance components to be used in thealgorithm for a particular catheter or arrangement of the system 10 aredetermined and the form of the algorithm/equation is resolved, thecomponents of the complex impedance (or an indication correspondingthereto), the equation to be used, and/or the specific terms of theequation (including, if appropriate, the constant(s) and/or coefficientsfor the equation terms) may be stored or programmed into the ECU 34, ora memory/storage device 73 (best shown in FIG. 1) associated therewithor accessible thereby. Alternatively, as described above, the catheter18 or another component in the system 10 may include a memory, such asan EEPROM, that is configured to store the above identified informationor a memory address for accessing the information stored in anothermemory location corresponding to that particular type of catheter and/orother equipment of the system 10. The ECU 34 may retrieve thisinformation or addresses directly or indirectly and use it to calculatethe predicted tissue temperature.

With reference to FIG. 14, an exemplary tissue temperature predictioncalculation will be described. For purposes of clarity, brevity, andillustration, the description below has been limited to an embodimentwherein the temperature is calculated based using the equation (9)above. It will be appreciated in view of the above, however, that thepresent disclosure is not meant to be limited to such an embodiment.

As an initial matter, in addition to being configured to calculate thepredicted tissue temperature described above, in an exemplaryembodiment, the ECU 34 is also configured to acquire and/or calculatethe terms used in the equation for making the calculation (i.e., P(dt),φ, dt, (ln dt), (ln P), etc.). In this embodiment, the ECU 34 isconfigured to acquire magnitudes for the components of the compleximpedance (i.e., X, R, Z, and φ), the magnitudes of the instantaneouspower (P) applied to the tissue 12, the elapsed time of the lesionformation process, and the temperature of the catheter tip.

More particularly, with reference to FIG. 14, the ECU 34 is configuredto acquire magnitudes for the pre-ablation phase angle φ₁ between theelectrode 16 and the tissue 12 prior to the electrode 16 contacting thetissue 12, and the pre-ablation phase angle φ₂ once the electrode 16contacts the tissue 12 (Step 142). These magnitudes may be received fromthe complex impedance sensor 64, and may be stored along in a temporaryor permanent memory or storage medium that is either part of, oraccessible by, the ECU 34, such as, for example, the memory 73.

The ECU 34 is further configured to acquire magnitudes for X, R, Z, P,and the temperature (T) of the catheter tip at a point in time t=t₂ atwhich the depth of the lesion is assessed (the lesion formation processcommencing at time t=t₁) (Step 144). The X, R, and Z magnitudes may bereceived from the complex impedance sensor 64, the P magnitude may bereceived from the ablation generator 26, or a reporting systemassociated therewith, and the T magnitude may be received from thetemperature-sensing electrode or temperature sensor or the ablationgenerator 26. Each magnitude may be correlated and/or stored along withthe corresponding time (i.e., t=t₂) in a memory or storage device suchas that described above in the manner, for example, illustrated in FIG.15. The ECU is still further configured to calculate the duration of thelesion formation process by calculating the change in time from when thelesion formation process commenced (i.e., time t=t₁), to when thetemperature calculation is being made (i.e., time t=t₂, for example).The duration (dt) may then be stored in a memory or storage device asdescribed above.

Because the temperature of the tissue may be assessed as the lesion isbeing formed such that the tissue temperature may be predicted/monitoredin real-time, the ECU 34 is further configured to sample the magnitudesfor X, R, Z, P, and T throughout the formation of the lesion at one ormore respective predetermined sampling rates in order to constantly andcontinuously monitor the predicted temperature of the tissue. In anexemplary embodiment, a sampling rate on the order of 100 to 800 timesper second may be used, however, the present disclosure is not meant tobe limited to such a range of rates but rather a sampling rate that isgreater than or less than 100 to 800 Hz may be used in differentembodiments. Accordingly, the ECU 34 is configured to sample the signalreceived from the complex impedance sensor 64 at a predetermined rateand to store the corresponding X, R, and Z, magnitudes (X₁, X₂, . . .,X_(n); R₁, R₂, . . . ,R_(n); and Z₁, Z₂, . . . ,Z_(n)) derivedtherefrom in the memory or storage medium described above along with thecorresponding times (i.e., t₁, t₂, . . . , t_(n)) at which the sampleswere taken (See FIG. 15). Similarly, the ECU 34 is configured to samplethe signals received from the ablation generator 26, or an associatedreporting system, and the temperature-sensing electrode or temperaturesensor (in an embodiment wherein the temperature-sensing electrode ortemperature sensor communicates with the ECU 34 directly) at apredetermined rate, and to store the corresponding power and temperaturevalues (P₁, P₂, . . . , P_(n) and T₁, T₂, . . . , T_(n)) in a memorysuch as that described above along with the corresponding times (i.e.,t₁, t₂, . . . , t_(n)) at which the samples were taken (See FIG. 15).

In an exemplary embodiment, after each set of samples of X, R, Z, P, andT is taken, the system 10 is configured to calculate the predictedtissue temperature described above. Alternatively, rather thancalculating the predicted temperature after each set of samples, the ECU34 may be configured to calculate the predicted temperature at someother rate such as after a certain number of sets of samples have beencollected, after a certain amount of time has elapsed, upon receivinginstructions from the user to do so, or after the lesion formationprocess has been completed. For the purposes of clarity and brevityalone, the description below will be directed to an embodiment whereinthe predicted depth is calculated after a set of samples of each of theX, R, Z, P, and T is collected at a particular point in time, which, forthis example, is time t=t₂. It will be appreciated, however that thepresent invention is not meant to be limited to such an embodiment.

Accordingly, after a set of samples of each of X, R, Z, P, and T arecollected, the ECU 34 is configured to perform a number of calculations.For example, and as illustrated in FIG. 14, the ECU 34 is configured tocalculate a change in the time (dt), or the elapsed time, represented bythe time interval from the point in time that the lesion formationprocess commenced (i.e., time t=t₁, in this embodiment) to the point intime that the current sample was taken (i.e., time t=t₂) (Step 146). TheECU 34 is further configured to multiply the magnitude of the power (P₂)with the change in time (dt) (Step 148), to calculate the change inphase angle (dφ) between φ₂ and φ₁ by subtracting φ₁ from φ₂ (Step 150),to calculate the natural log of the magnitude of the duration or changein time (dt) (Step 152), and to calculate the natural log of the power(P₂) applied to the tissue (Step 154).

Once all of the terms above are calculated, the ECU 34 is configured andable to calculate the predicted tissue temperature at that point in time(Step 156). Accordingly, using equation (9) above as an example, the ECU34 is configured to acquire the correct or appropriate values for theconstant a and the coefficients b₁-b₉, and to process these values withthe terms described above to come to a predicted temperature of thetissue a predetermined depth below the surface of the tissue 12 (i.e.,in this embodiment, 3 mm below the endocardial surface). Accordingly,the computer program stored or accessible by the ECU 34 includes codefor carrying out the execution of the predicted temperature equation.Once the predicted temperature is calculated, it may be used in a numberof ways, such as, for example, in the same manner as was described abovein great detail for the calculated predicted lesion depth (i.e., thecalculated temperature may be used and displayed in same manner as thecalculated predicted lesion depth). Accordingly, the description aboverelating to the use and display of the predicted lesion depth applieshere with equal force, and therefore, will not be repeated in itsentirety.

However, for illustrative purposes only, in one exemplary embodiment,the ECU 34 is configured to generate a signal representative of anindicator or indication of the predicted temperature, and may be furtherconfigured to control a display, such as, for example, the display 36,to display the indicator represented by the signal generated by the ECU34. In other words, the calculated temperature may be displayed for theuser of the system 10 to see (Step 158). In one exemplary embodiment,the predicted tissue temperature may be displayed in numerical form(e.g., a digital readout) on the display 36 of the visualization,mapping, and navigation system 32, as generally illustrated in FIG. 8a .In other embodiments, the predicted tissue temperature may be displayed,not in numerical form (e.g., a digital readout), but as a visualrepresentation indicative of the predicted tissue temperature. Thevisual representation 222 indicative of the predicted tissue temperaturemay comprise a graph (e.g., bar graph or graph of any other shape), ameter, a “stop light” design comprising three, vertically stackedcircular images, an indicator needle, a “gas tank gauge,” or any numberof other visual representations that may be used to indicate atemperature. Although the visual representation of predicted tissuetemperature is generally illustrated as a bar graph in FIG. 8c , anynumber of other visual representations may be used in accordance withother embodiments of the invention. Different colors, shapes, and/orsizes of images may be used as a visual representation 222 indicative ofpredicted tissue temperature. Although FIG. 8a includes only thenumerical form of the tissue temperature on the display 36 of thevisualization, mapping, and navigation system 32, both the numericalform and a visual representation 222 may be displayed in accordance withother embodiments of the system 10, as generally illustrated in FIG. 8c. In other embodiments, only the visual representation indicative of thepredicted tissue temperature may be displayed. In addition to a visualrepresentation indicative of the predicted tissue temperature, there maybe other visual indications of the predicted tissue temperature such asmessages, warnings, alerts, lights, color changes, blinking, specializedimages, and/or any of other numerous visual indications known to thoseof ordinary skill in the art. In addition to and/or instead of thevisual representation indicative of the predicted tissue temperature,there may also be at least one of an audible indication (e.g., buzzer,alarm, audible message, etc.), a tactile indication, and/or avibrational indication of the predicted tissue temperature. The audibleindication, tactile indication, and/or vibrational indication may beused in connection with the catheter 18 (e.g., handle 44) in order toprovide feedback to the user (e.g., clinician or physician) of thesystem 10. For example, the audible indication, tactile indication,and/or vibrational indication may be presented if a value indicative ofthe predicted tissue temperature of the target tissue exceeds apredetermined threshold. The value of the predetermined threshold may beinput into ECU 34 through the input interface of the ECU 34.

The temperature magnitude may also be displayed with the duration oftime that the temperature has remained at that temperature, and/or alongwith a log of prior temperature calculations. This embodiment providesthe physician or clinician using the system 10 with a real-timeindication of tissue temperature. Accordingly, if the ECU 34 calculatesthe predicted tissue temperature at 3 mm below the surface of the tissue12 is 50° C., a reading of “50° C.” will be displayed on the display 36.Based on the displayed predicted temperature, and using his/herexperience, the user of the system 10 may be able to interpret thedisplayed temperature to determine the depth of the lesion being formedat that particular location. More particularly, if the temperaturereaches a predetermined magnitude, the user may be able to tell that thelesion has reached the depth to which the temperature corresponds. Forexample, if the calculated temperature corresponds to the predictedtemperature of the tissue 3 mm below the surface of the tissue, based onthe displayed calculated temperature, the user may be able to determinewhether or not the lesion has reached a depth of 3 mm. Accordingly,rather than the system 10 predicting the lesion depth, in thisembodiment, the system 10 predicts the temperature of the tissue apredetermined depth below the surface, and then the user of the systeminterprets the predicted temperature to assess the lesion depth forhimself/herself. Thus, the system 10 in this embodiment provides a toolthat the user of the system 10 may use to assess lesion depth, asopposed to assessing lesion depth itself.

It will be appreciated that while the description above has been limitedto an embodiment wherein the predicted temperature corresponds to thetemperature of the tissue at a depth of 3 mm below the surface of thetissue, the present disclosure is not meant to be limited to such anembodiment. Rather, it is contemplated that the tissue temperature atdepths greater than or less than 3 mm below the surface of the tissuemay be predicted in a similar manner to that described above, andtherefore, embodiments of the system 10 for predicting temperatures atdepths other than 3 mm remain within the spirit and scope of the presentdisclosure.

Regardless of how the calculated predicted temperature is processedand/or displayed, once the predicted temperature has been calculated andevaluated for a set of samples taken at a predetermined point in time,in an exemplary embodiment, the system 10 may be configured to repeatthe above-described process for a set of subsequent samples taken at asubsequent point in time in accordance with a predetermined rate ofcalculating the predicted temperature (i.e., for each set of samplestaken for X, R, P, T, Z, and dt, for example; after a predeterminednumber of sets of samples are taken; after predetermined amount of timehas elapsed, etc.). The process may be continuously repeated at a givenrate until, for example, the physician or clinician terminates theprocess, or the lesion formation process has been otherwise stopped.

In another exemplary embodiment, the ECU 34 may be configured togenerate a signal representative of an indicator or indication of apredicted likelihood of steam pop (or endocardial barotrauma), and mayfurther be configured to control a display, such as, for example, thedisplay 36, to display the indicator represented by the signal generatedby the ECU 34. Steam pop is also referred to in the art as “tissue pop.”Steam pop is well known to clinicians, physicians, electrophysiologistsand other users of ablation systems. In particular, when the interfacebetween the electrode 16 and the tissue 12 increases rapidly above theboiling point as a result of the energy applied to the tissue, it canvaporize water and/or blood, thus causing an audible pop. If the waterand/or blood is contained within the tissue, the vaporization may causedisruption to the tissue. In particular, steam popping may result fromthe formation of bubbles within heated tissue, and the expansion and/orrupturing of tissue by these bubbles. Steam popping caused by theexpansion of bubbles may result in the undesirable tearing of tissue andthe release of emboli and/or micro-bubbles into blood.

Numerous factors may have an impact on the algorithm for the predictedlikelihood of steam pop. These factors include, for example and withoutlimitation: the reactance, the resistance, the impedance, and the phaseangle components of the complex impedance between the electrode 16 andthe tissue 12, the instantaneous power applied to the tissue 12 at thepoint in time for which the predicted likelihood of steam pop is made,the duration of the lesion formation process, the temperature of the tipof the catheter, and the calculated predicted temperature. Various otherfactors would possibly have an impact on the algorithm for the predictedlikelihood of steam pop including, for example and without limitation,certain parameters and/or characteristics of the equipment and/orarrangement of the system 10 (such as, for example, the type of catheterand ablation generator being used, the irrigation flow rate, etc.), aswell as the depth below the surface (e.g., endocardial surface) of thetissue 12 for which the temperature is being predicted.

Accordingly, a visual representation indicative of the predictedlikelihood of steam pop may be displayed for the user of the system 10to see. In one exemplary embodiment, the predicted likelihood of steampop may be displayed as a percentage in numerical form (e.g., digitalreadout) on the display 36 of the visualization, mapping, and navigationsystem 32, as generally illustrated in FIG. 8a . In other embodiments,the predicted likelihood of steam pop may be displayed as a visualrepresentation 224 comprising a graph (e.g., bar graph or graph of anyother shape), meter, a “stop light” design comprising three, verticallystacked circular images, an indicator needle, a “gas tank gauge,” or anynumber of other visual representations that may be indicative of thepredicted likelihood of steam pop. Different colors, shapes, and/orsizes of images may be used as a visual representation indicative of thepredicted likelihood of steam pop. Although FIG. 8a includes only thenumerical form of the likelihood of steam pop on the display 36 of thevisualization, mapping, and navigation system 32, both the numericalform and a visual representation 224 may be displayed in accordance withother embodiments of the system 10, as generally illustrated in FIG. 8c. In other embodiments, only the visual representation indicative of thepredicted likelihood of steam pop may be displayed. In addition to avisual representation indicative of the predicted likelihood of steampop as described above, there may be other visual indications of thepredicted likelihood of steam pop such as messages, warnings, alerts,lights, color changes, blinking, specialized images, and/or any of othernumerous visual indications known to those of ordinary skill in the art.For example, as generally illustrated in FIG. 8c , the visualrepresentation 224 of predicted likelihood of steam pop may comprise astatus message (e.g., “Steam pop likely” or “Steam pop not likely”). Inaddition to the visual representation 224 indicative of the predictedlikelihood of steam pop, the system 10 may further include a sensitivityslider bar 223. The sensitivity slider bar 223 may be configured toallow the user to adjust the sensitivity of the system 10 with regard tothe algorithm used in connection with the predicted likelihood of steampop. Although a slider bar is described in detail, other interfaces maybe used to adjust the sensitivity of the system 10 with regard to thepredicted likelihood of steam pop. In particular, the sensitivity sliderbar 223 may be used to change the level of the threshold against whichthe gathered data for steam pop prediction will be compared (i.e., alower threshold may make it more likely that a steam pop will bepredicted and the visual representation 224 will change from “Steam popnot likely” to “Steam pop likely,” and a higher threshold may make isless likely that a steam pop will be predicted and the visualrepresentation 224 will change from “Steam pop not likely” to “Steam poplikely.”). Increased sensitivity (e.g., a lower threshold) may result infewer false negative predictions, but more false positive predictions.Decreased sensitivity (e.g., a higher threshold) may result in fewerfalse positive predictions, but more false negative predictions. Inaddition to and/or instead of the visual representation indicative ofthe predicted likelihood of steam pop, there may also be at least one ofan audible indication (e.g., buzzer, alarm, audible message, etc.), atactile indication, and/or a vibrational indication of the predictedlikelihood of steam pop. The audible indication, tactile indication,and/or vibrational indication may be used in connection with thecatheter 18 (e.g., handle 44) in order to provide feedback to the user(e.g., clinician or physician) of the system 10. For example, theaudible indication, tactile indication, and/or vibrational indicationmay be presented if a value indicative of the predicted likelihood ofsteam pop of the target tissue exceeds a predetermined threshold. Thevalue of the predetermined threshold may be input into ECU 34 throughthe input interface of the ECU 34.

In accordance with another aspect of the disclosure, the system 10 maytake the form of an automated catheter system 82, such as, for exampleand without limitation, a robotic catheter system or a magnetic-basedcatheter system. As will be described below, the automated cathetersystem 82 may be fully or partially automated, and so may allow for atleast a measure of user control through a user input.

In the embodiment wherein the automated catheter system 82 is a roboticcatheter system (i.e., robotic catheter system 82), a robot is used, forexample, to control the movement of the catheter 18 and/or to carry outtherapeutic, diagnostic, or other activities. In an exemplaryembodiment, the robotic catheter system 82 may be configured such thatinformation relating to the calculated predicted lesion depth and/ortissue temperature may be communicated from the ECU 34 to a controlleror control system 84 of the robotic catheter system 82. In an exemplaryembodiment, the ECU 34 and the controller 84 are one in the same.However, in another exemplary embodiment, the two are separate anddistinct components. For ease of description purposes only, thefollowing description will be directed to the latter, separate anddistinct arrangement. It should be noted, however, that the embodimentwherein the controller 84 and the ECU 34 are the same remains within thespirit and scope of the present invention.

The information communicated to the controller 84 may be in the form ofsignal(s) generated by the ECU 34 that are representative of thepredicted lesion depth or temperature. As will be described in greaterdetail below, the controller/control system 84 may use this informationin the control and operation of the robotic catheter system 82. Withreference to FIGS. 16 and 17, the robotic catheter system 82 will bebriefly described. A full description of the robotic catheter system 82is set forth in commonly-assigned and co-pending U.S. patent applicationSer. No. 12/347,811 entitled “Robotic Catheter System,” the disclosureof which is hereby incorporated by reference herein in its entirety.

Accordingly, FIGS. 16 and 17 illustrate the robotic catheter system 82.The robotic catheter system 82 provides the ability for precise anddynamic automated control in, for example, diagnostic, therapeutic,mapping, and ablative procedures. In an exemplary embodiment, therobotic catheter system 82 includes one or more robotic cathetermanipulator assemblies 86 supported on a manipulator support structure88. The robotic catheter manipulator assembly 86 may include one or moreremovably mounted robotic catheter device cartridges 90, for example,that are generally linearly movable relative to the robotic cathetermanipulator assembly 86 to cause the catheter associated therewith(i.e., catheter 18) to be moved (e.g., advanced, retracted, etc.). Thecatheter manipulator assembly 86 serves as the mechanical control forthe movements or actions of the cartridge 90. The robotic cathetersystem 82 may further include a human input device and control system(“input control system”) 92, which may include a joystick and relatedcontrols with which a physician/clinician may interact to control themanipulation of the cartridge 90, and therefore, the catheter 18 of thesystem 82. The robotic catheter system 82 may still further include anelectronic control system 94, which, in an exemplary embodiment,consists of or includes the controller 84, which translates motions ofthe physician/clinician at the input device into a resulting movement ofthe catheter. As with the system 10 described above, the roboticcatheter system 82 may further include the visualization, mapping, andnavigation system 32, to provide the clinician/physician with real-timeor near-real-time positioning information concerning the catheter andvarious types of anatomical maps, models, and/or geometries of thecardiac structure of interest, for example.

In addition to, or instead of, the manual control provided by the inputcontrol system 92, the robotic catheter system 82 may involve automatedcatheter movement. For example, in one exemplary embodiment, aphysician/clinician may identify locations (potentially forming a path)on a rendered computer model of the cardiac structure. The system 82 canbe configured to relate those digitally selected points to positionswithin the patient's actual/physical anatomy, and may command andcontrol the movement of the catheter 18 to defined positions. Once in adefined position, either the physician/clinician or the system 82 couldperform desired treatment or therapy, or perform diagnostic evaluations.The system 82 could enable full robotic control by using optimized pathplanning routines together with the visualization, mapping, andnavigation system 32.

As briefly described above, in an exemplary embodiment, informationrelating to the predicted lesion depth, the likelihood that a lesion hasreached a predetermined depth, or predicted tissue temperature is inputinto controller 84 and may be used in the control and operation of therobotic catheter system 82. In an exemplary embodiment, the informationis generated by, for example, the ECU 34 as described in great detailabove. This information is then communicated by the ECU 34 to thecontroller 84. In one exemplary embodiment the information is simplystored within the robotic catheter system 82. Accordingly, noaffirmative action is taken by the controller 84, or any other componentof the robotic catheter system 82, in response to the information. Inanother exemplary embodiment, however, the information may be used bythe robotic catheter system 82 to control one or more aspects of theoperation of the system 82.

More particularly, in an exemplary embodiment, when it is determined,based on, for example, the calculated predicted lesion depth, that alesion of a particular depth has been formed in the tissue 12, thecontroller 84 may be configured to retract or move the catheter 18 awayfrom the tissue 12. The controller 84 may also be configured to causethe RF power being applied to the tissue 12 to be reduced or turned offcompletely. In such an instance, the controller 84 would be connected tothe ablation generator 26 either directly or indirectly through, forexample, the ECU 34 to allow communication between the controller 84 andthe ablation generator 26 to reduce or turn-off the power applied to thetissue 12.

In another exemplary embodiment, instead of the controller 84 taking theaffirmative steps to move away from the tissue or causing the powerapplied to the tissue 12 to be reduced or turned off, the controller 84is configured to inquire as to whether the ablation procedure should goon, whether the controller 84 should move the catheter 18, whether thepower should be reduced, etc. This inquiry may be directed to aphysician/clinician, the ECU 34, or another component within the system82. Depending on the feedback the controller 84 receives, it may takethe necessary actions to carry out the instructions embodied by thefeedback.

It will be appreciated that while the description thus far has beenprimarily with respect to an RF-based ablation system, the disclosureherein is not meant to be so limited. Rather, one of ordinary skill inthe art will appreciate that the disclosure herein may find applicationwith ablation systems other than RF-based ablation systems, such as, forexample and without limitation, high intensity ultrasound (HIFU)ablation systems, cryogenic ablation systems, chemical ablation systems,and laser-based ablation systems. Accordingly ablation systems otherthan RF-based ablation systems remain within the spirit and scope ofthis disclosure.

With reference to FIG. 18, an exemplary embodiment of the automatedcatheter guidance system 82 comprising a magnetic-based catheter system(i.e., magnetic-based catheter system 82′) is illustrated. In oneexemplary embodiment, one or more externally generated magnetic fieldsproduced by one or more electromagnets are used to move, guide, and/orsteer a magnetically-tipped catheter through a patient's body. Theexternally generated magnetic fields exert a desired torque on thecatheter to cause the position of the catheter to be manipulated in adesired way (e.g., advance, retract, bend, rotate, speed up, slow down,etc.). Accordingly, as with the robotic catheter system described above,the magnetic fields may be used to control the movement of the catheter18 and/or to allow the system 10 to carry out therapeutic, diagnostic,or other activities at given locations within the patient's body. A fulldescription of a magnetic-based catheter system is set forth in U.S.Pat. No. 6,507,751 entitled “Method and Apparatus Using Shaped Field ofRepositionable Magnet to Guide Implant,” and U.S. Published PatentApplication No. 2007/0016006 A1 entitled “Apparatus and Method forShaped Magnetic Field Control for Catheter, Guidance, Control, andImaging,” the disclosures of which are hereby incorporated by referenceherein in their entireties.

In an exemplary embodiment, the magnetic-based catheter system 82′ maybe configured such that information relating to the calculated predictedlesion depth or tissue temperature, or the determination as to thelikelihood that the lesion has reached a predetermined depth may becommunicated from the ECU 34 to a controller or control system 84′ ofthe magnetic-based catheter system 82′. In an exemplary embodiment, theECU 34 and the controller 84′ are one in the same. However, in anotherexemplary embodiment, the two are separate and distinct components. Forease of description purposes only, the following description will bedirected to the latter, separate and distinct arrangement. It should benoted, however, that the embodiment wherein the controller 84′ and theECU 34 are the same remains within the spirit and scope of the presentinvention.

The information communicated to the controller 84′ may be in the form ofthe signal(s) described above representative of the calculated lesiondepth, tissue temperature, and/or likelihood that the lesion has reacheda predetermined depth. As will be described in greater detail below, thecontroller/control system 84′ may use this information in the controland operation of the magnetic-based catheter system 82′.

As with the robotic catheter system described above, the magnetic-basedcatheter system 82′ provides the ability for precise and dynamicautomated control in, for example, diagnostic, therapeutic, mapping, andablative procedures. In an exemplary embodiment, the magnetic-basedcatheter system 82′ includes somewhat similar structure to that of therobotic catheter system described above to effect the movement of thecatheter 18. For example, system 82′ may comprise a catheter manipulatorassembly 86′ that includes, in part, one or more external magnetic fieldgenerators configured to create the magnetic field(s) required to inducethe movement of the catheter 18, and a magnetic element 96 mountedthereon or therein. The system 82′ may further comprise supportstructures and the like to support catheter 18. As also with the roboticcatheter system, the magnetic-based catheter system 82′ may furtherinclude a human input device and control system (“input controlsystem”), which may include a joystick and related controls with which aphysician/clinician may interact to control the manipulation thecatheter 18. In one exemplary embodiment, the system 82′ is configuredsuch that the physician or clinician may input a command for thecatheter to move in a particular way. The system 82′ processes thatinput and adjusts the strength and/or orientation of the externalmagnetic fields to cause the catheter 18 to move as commanded. Themagnetic-based catheter system 82′ may also still further include anelectronic control system, which, as with the electronic control systemof the robotic catheter system described above, may consist of orinclude the controller 84′, that translates motions of thephysician/clinician at the input device into a resulting movement of thecatheter. Finally, in an exemplary embodiment, the magnetic-basedcatheter system 82′ may further include the visualization, mapping andnavigation system 32, to provide the clinician/physician with real-timeor near-real-time positioning information concerning the catheter andvarious types of anatomical maps, models, and/or geometries of thecardiac structure of interest, for example.

As briefly described above, in an exemplary embodiment, informationrelating to the calculated lesion depth or tissue temperature, or thelikelihood that the lesion has reached a predetermined depth, is inputinto controller 84′ and may be used in the control and operation of themagnetic-based catheter system 82′. In an exemplary embodiment, theinformation is generated by, for example, the ECU 34 as described ingreat detail above. This information is then communicated by the ECU 34to the controller 84′. In one exemplary embodiment the information issimply stored within the magnetic-based catheter system 82′.Accordingly, no affirmative action is taken by the controller 84′, orany other component of the magnetic-based catheter system 82′, inresponse to the information. In another exemplary embodiment, however,the information may be used by the magnetic-based catheter system 82′ tocontrol one or more aspects of the operation of the system 82′.

More particularly, in an exemplary embodiment, when it is determined,based on, for example, the calculated lesion depth, that a lesion of aparticular depth has been formed, the controller 84′ may be configuredto retract or move the catheter 18 away from the tissue 12 by adjustingthe strength and/or orientation of the external magnetic field. Thecontroller 84′ may also be configured to cause the RF power beingapplied to the tissue 12 to be reduced or turned off completely. In suchan instance, the controller 84′ would be connected to the ablationgenerator 26 either directly or indirectly through, for example, the ECU34 to allow communication between the controller 84′ and the ablationgenerator 26 to reduce or turn-off the power applied to the tissue 12.

In another exemplary embodiment, instead of the controller 84′ takingthe affirmative steps to move away from the tissue or causing the powerapplied to the tissue 12 to be reduced or turned off, the controller 84′is configured to inquire as to whether the ablation procedure should goon, whether the controller 84′ should move the catheter 18, whether thepower should be reduced, etc. This inquiry may be directed to aphysician/clinician, the ECU 34, or another component within the system82′. Depending on the feedback the controller 84′ receives, it may takethe necessary actions to carry out the instructions embodied by thefeedback.

It will be appreciated that in addition to the structure of the system10 and the article of manufacture described above, another aspect of thepresent disclosure is a method for assessing the formation of a lesionin tissue on which an ablation procedure is being performed is provided.With respect to FIG. 4, and in its most general form, the methodincludes a first step 100 of acquiring, by the ECU 34, one or morevalues for one or more components of a complex impedance between theelectrode 16 and the tissue 12. A second step 102 includes acquiring, bythe ECU 34, a value for the power applied to the tissue 12 during theformation of the lesion therein. A third step 104 includes calculating,by the ECU 34, a value responsive to the magnitudes for the one or morecomplex impedance components and the applied power, wherein the value isindicative of one of a predicted lesion depth, a likelihood that thelesion has reached a predetermined depth, and a predicted tissuetemperature.

With reference to FIG. 6, a more detailed description of one exemplaryembodiment of the method will be described. In this embodiment, thecalculated value is indicative of a predicted lesion depth. In theinterest of clarity and brevity, the methodology will be describedsolely with respect to equation (3) above. It will be appreciated,however, that the present disclosure is not meant to be limited solelyto this prediction algorithm or methodology.

In such an embodiment, magnitudes for first and second components of thecomplex impedance are acquired. These components comprise resistance (R)and phase angle (φ). Accordingly, in step 106, a magnitude of thepre-ablation phase angle between the electrode 16 and the tissue 12 isacquired by the ECU 34 corresponding to a point in time prior to thecommencement of the lesion formation process (i.e., time t=t₀).Additionally, magnitudes for the resistance and the phase angle betweenthe electrode 16 and the tissue 12 are acquired by the ECU 34corresponding to a point in time at which the lesion formation processcommences (i.e., just after initiation of RF power/energy delivery tothe tissue 12) (i.e., time t=t₁). In step 108, magnitudes for theresistance and phase angle between the electrode 16 and the tissue 12corresponding to the time at which the lesion depth is being predicted,as well as a magnitude of the average power applied to the tissue tothat point in the lesion formation process, are acquired by the ECU 34.

In step 110, the ECU 34 calculates a change in resistance (dR) betweenthe resistance magnitude corresponding to the point in time at which thelesion formation process commences (i.e., time t=t₁) and the resistancemagnitude corresponding to the point in time at which the lesion depthis being predicted. In step 112, the ECU 34 calculates or determines achange in time (dt), or the amount of elapsed time between the start ofthe lesion formation process and the time at which the predicted depthis being calculated.

In step 114, the ECU 34 calculates a change in phase angle (dφ) betweenthe phase angle magnitude corresponding to the point in time at whichthe lesion formation process commences (i.e., time t=t₁) and the phaseangle magnitude corresponding to the point in time at which the lesiondepth is being predicted.

In step 116, the natural log of the magnitude of the average power iscalculated by the ECU 34.

Once each of the above described calculations are made, the ECU 34 isconfigured to acquire the appropriate values for the constant andcoefficients of the predicted depth equation, and to then process thesevalues with the calculations described above to calculate the predicteddepth (Step 117). More particularly, step 117 includes summing apredetermined constant with: the product of a first coefficient and thenatural log of the average power; the product of a second coefficientand the term (dt); the product of a third coefficient and the magnitudeof the pre-ablation phase angle; the product of a fourth coefficient andthe term dR; and the product of a fifth coefficient and the term dφ.

With continued reference to FIG. 6, in an exemplary embodiment, themethod further includes a step 118 that includes generating, by the ECU34, a signal or indicator representative of the calculated predictedlesion depth, and controlling, by the ECU 34, a display device, such as,for example, the display 36, to display the predicted lesion depth, oran indicator thereof, represented by the signal generated by the ECU 34.This display may be in the form of a numeric display, or some otherform, such as, for example, markers on an image/model. The ECU 34 isfurther configured to repeat the above described methodology using R, φ,and Avg.P samples corresponding to a subsequent point in time in thelesion formation process.

With reference to FIGS. 9a and 9b , in another exemplary embodimentdescribed in great detail above, rather than displaying the predictedlesion depth as described above, the method further includes a step 120of setting at least one target lesion depth, and a step 122 of comparingthe calculated predicted depth to the target. In this embodiment, thedisplay step 118 of the method comprises displaying an indication touser as to whether the predicted depth meets, exceeds, or falls belowthe target. Accordingly, the ECU 34 is configured to compare thepredicted depth to one or more targets, to generate one or more signalsrepresentative of one or more indicators corresponding to the result ofthe comparison(s), and to control the display 36 to display theindicator(s) represented by the generated signal(s). As with theembodiment above, once the indicator is displayed, the ECU 34 isconfigured to repeat the above described process for a subsequent set ofsamples.

With respect to FIG. 10, a more detailed description of anotherexemplary embodiment of the method of assessing the formation of alesion in a tissue 12 will be provided. In this embodiment, thecalculated value is indicative of a likelihood that the lesion hasreached a predetermined depth. In the interest of clarity and brevity,the methodology will be described solely with respect to equation (7)above. It will be appreciated, however, that the present disclosure isnot meant to be limited solely to this particular algorithm ormethodology of assessing the likelihood that a lesion has reached apredetermined depth.

In such an embodiment, in step 124, magnitudes for the resistance (R₁)and reactance (X₁) between the tissue 12 and the electrode 16 at thepoint in time at which the lesion formation process commences (i.e.,time t=t₁) are acquired, and an ECI (ECI₁) is calculated based on R₁ andX₁.

In step 126, magnitudes of the resistance (R₂) and reactance (X₂)between the tissue 12 and the electrode 16 at the point in time at whichthe lesion depth is assessed (i.e., time t=t₂) are acquired, and an ECI(ECI₂) is calculated based on R₂ and X₂.

In step 128, a magnitude for the average power (Avg.P) applied to thetissue 12 during the lesion formation process is acquired.

In step 130, a magnitude for the change in time between the onset of thelesion formation process and the time at which the lesion depth isassessed, or the duration of the lesion formation process, is calculated(dt); and in step 132, the natural log of the magnitude of the change intime (dt) is calculated.

In step 134, the change in the ECI between the onset of the lesionformation process and the time at which the lesion depth is assessed iscalculated (dECI).

Once each of the above described calculations are made, the ECU 34 isconfigured to acquire the appropriate values for the constant andcoefficients of the equation, and to then process these values with thecalculations described above to calculate the value or index (Step 136).More particularly, step 136 includes summing a predetermined constantwith: the product of a first coefficient and magnitude of the averagepower (Avg.P); the product of a second coefficient and the natural logof the magnitude of the change in time (dt); and the product of a thirdcoefficient and the magnitude of the change in ECI (dECI).

With continued reference to FIG. 10, the method further includes a step138 of comparing, by the ECU 34, the calculated value or index to athreshold, and generating a signal representative of an indicator thatthe depth is above or below the target depth based on the comparison ofthe value/index with the threshold. In an exemplary embodiment, themethod further includes a step 140 of controlling, by the ECU 34, thedisplay device to display the indicator represented by the generatedsignal. Additionally, in an exemplary embodiment, the method may furtherinclude a step 137 performed prior to the comparison step 138 thatcomprises adjusting the threshold value. More particularly, step 137 mayinclude receiving, by the ECU 34, an input from a user input device,such as, for example, user input device 80, and then adjusting thethreshold value in response to the user input.

In an exemplary embodiment, the system 10, and the ECU 34, inparticular, is further configured to repeat the above describedmethodology using samples corresponding to a subsequent point in time inthe lesion formation process.

In alternate exemplary embodiments, the method further includes, asdescribed in greater detail above, one or more of the steps of:receiving, from a user input device, an input corresponding to thedesired target depth (i.e., adjusting the target depth); receiving, froma user input device, an input corresponding to the desired sensitivityof the system (i.e., adjusting the threshold); and calculating a valueor index for a second target depth simultaneous with the calculation ofthe value or index for a first target depth.

With reference to FIG. 14, a more detailed description of anotherexemplary embodiment of the method of assessing the formation of alesion in a tissue 12 will be provided. In this embodiment, thecalculated value is indicative of a predicted temperature of the tissuea predetermined depth below the surface of the tissue. In the interestof clarity and brevity, the methodology will be described solely withrespect to equation (9) above. It will be appreciated, however, that thepresent disclosure is not meant to be limited solely to this predictionalgorithm or methodology.

In such an embodiment, in step 142, magnitudes for the pre-ablationphase angle between the electrode 16 and the tissue 12 both prior to(φ₁) and following (φ₂) the catheter 18 contacting the tissue 12 areacquired. In step 144, magnitudes for the resistance, reactance, andimpedance between the electrode 16 and the tissue 12, the magnitude ofthe instantaneous power applied to the tissue 12, and the magnitude ofthe temperature of the tip of the catheter 18, all corresponding to thetime at which the temperature of the tissue is being predicted, areacquired by the ECU 34.

In step 146, the ECU 34 calculates or determines a change in time (dt),or the amount of elapsed time between the start of the lesion formationand the time at which the predicted temperature is being calculated. Instep 148, the ECU 34 multiplies the magnitude of the instantaneous powerwith the change in time (dt).

In step 150, the ECU 34 calculates the change in pre-ablation phaseangle (dφ) based on phase angle magnitudes φ₁ and φ₂.

In step 152, the natural log of the magnitude of change in time (dt) iscalculated by the ECU 34; and in step 154, the natural log of themagnitude of the instantaneous power applied to the tissue 12 iscalculated by the ECU 34.

Once each of the above described calculations are made, the ECU 34 isconfigured to acquire the appropriate values for the constant andcoefficients of the predicted temperature equation, and to then processthese values with the calculations described above to calculate thepredicted temperature (Step 156). More particularly, step 156 includessumming a predetermined constant with: the product of a firstcoefficient and magnitude of the reactance (X); the product of a secondcoefficient and magnitude of the resistance (R); the product of a thirdcoefficient and the magnitude of the power (P) applied to the tissue 12;the product of a fourth coefficient and the magnitude of the temperatureof the catheter tip (T); the product of a fifth coefficient and themagnitude of the impedance (Z); the product of a sixth coefficient andthe product of the power (P) applied to the tissue and the term (dt);the product of seventh coefficient and the term dφ; the product of aneighth coefficient and the natural log of the term (dt); and the productof a ninth coefficient and the natural log of the power applied to thetissue 12.

With continued reference to FIG. 14, in an exemplary embodiment, themethod further includes a step 158 that includes generating, by the ECU34, a signal or indicator representative of the calculated predictedtemperature, and controlling, by the ECU 34, a display device, such as,for example, the display 36, to display the predicted temperature, or anindicator thereof, represented by the signal generated by the ECU 34.This display may be in the form of a numeric display, or some otherform, such as, for example, markers on an image/model. The ECU 34 isfurther configured to repeat the above described methodology usingsamples corresponding to a subsequent point in time in the lesionformation process.

It should be noted that the processes described above arelesion-by-lesion processes. As such, for each new lesion that isperformed during an ablation process (multiple lesions may be performedduring a single ablation process), the values for the factors used inthe equation (s) for calculating the value must be reevaluated and resetin order for the calculated values to be accurate. In order for thesystem 10, and the ECU 34, in particular, to know when a new lesion isbeing performed, and therefore, when to reset and/or reevaluate theappropriate values or factors, the system 10 may further include a meansor mechanism for informing the ECU 34 that a new lesion formationprocess is commencing. In an exemplary embodiment, the system 10includes a user input device, such as, for example and withoutlimitation, a trigger mechanism on the handle 44 of the catheter 18, abutton associated with the visualization, mapping, and navigation system32, or a device such as that described above with respect to user inputdevice 80, that is electrically connected to, and configured forcommunication with, the ECU 34 to allow the user to indicate when a newlesion formation process is commencing. Alternatively, this may becarried out algorithmically by having the system 32, for example,determine the start of a lesion based on detection of catheter stabilityor some other factor/attribute. In yet another embodiment, the system 10is configured, based on the input to ECU 34 from the ablation generator26, to determine when one lesion formation process is concluded, andwhen another lesion formation process is commencing. Accordingly, it iscontemplated that any number of means or mechanisms could be used toinform the ECU 34 that a lesion formation process is about to commence,or has commenced, and each of these means/mechanisms remain within thespirit and scope of the present invention.

It should be understood that the system 10, particularly ECU 34, asdescribed above may include conventional processing apparatus known inthe art, capable of executing pre-programmed instructions stored in anassociated memory, all performing in accordance with the functionalitydescribed herein. It is contemplated that the methods described herein,including without limitation the method steps of embodiments of thedisclosure, will be programmed in a preferred embodiment, with theresulting software being stored in an associated memory and where sodescribed, may also constitute the means for performing such methods.Implementation of the invention, in software, in view of the foregoingenabling description, would require no more than routine application ofprogramming skills by one of ordinary skill in the art. Such a systemmay further be of the type having both ROM, RAM, a combination ofnon-volatile and volatile (modifiable) memory so that the software canbe stored and yet allow storage and processing of dynamically produceddata and/or signals.

Although several embodiments of this disclosure have been describedabove with a certain degree of particularity, those skilled in the artcould make numerous alterations to the disclosed embodiments withoutdeparting from the scope of this disclosure. All directional references(e.g., upper, lower, upward, downward, left, right, leftward, rightward,top, bottom, above, below, vertical, horizontal, clockwise andcounterclockwise) are only used for identification purposes to aid thereader's understanding of the present disclosure, and do not createlimitations, particularly as to the position, orientation, or use of thesystem, article of manufacture and methodology of the presentdisclosure. Joinder references (e.g., attached, coupled, connected, andthe like) are to be construed broadly and may include intermediatemembers between a connection of elements and relative movement betweenelements. As such, joinder references do not necessarily infer that twoelements are directly connected and in fixed relation to each other. Itis intended that all matter contained in the above description or shownin the accompanying drawings shall be interpreted as illustrative onlyand not as limiting. Changes in detail or structure may be made withoutdeparting from the disclosure as defined in the appended claims.

What is claimed is:
 1. A graphical user interface system for displayingcharacteristics of target tissue during an ablation procedure, thesystem comprising: an electronic control unit (ECU) configured to:receive as an input data a complex impedance measured between a firstelectrode and the target tissue for a time period during the ablationprocedure, wherein the time period is a time during which ablationenergy is applied to the target tissue, receive at least onecharacteristic of the target tissue, receive a signal indicative of acontact force measured between a second electrode and the target tissuefor the time period, determine a predicted depth value of a lesion inthe target tissue based on each of the following: i) the compleximpedance, ii) the time period, and iii) the signal indicative of thecontact force, associate the predicted depth value with the at least onecharacteristic of the target tissue, and output the predicted depthvalue; and a display device operatively connected to the ECU, whereinthe display device is configured to receive the predicted depth valueand display a visual representation of the predicted depth value of thelesion in the target tissue for the time period.
 2. The graphical userinterface system of claim 1, wherein the visual representation isdisplayed during the time period.
 3. The graphical user interface systemof claim 1, wherein the at least one characteristic of the target tissuecomprises a thickness of the target tissue.
 4. The graphical userinterface system of claim 3, wherein the display device is furtherconfigured to display a visual representation indicative of thethickness of the target tissue.
 5. The graphical user interface systemof claim 4, wherein the visual representation of the predicted depthvalue of the lesion in the target tissue for the time period comprisesan expandable graph or meter.
 6. The graphical user interface of claim5, wherein the expandable graph or meter is at least partially overlaidover the visual representation indicative of the thickness of the targettissue.
 7. The graphical user interface system of claim 1, wherein thedata regarding the complex impedance is generated by measuringelectrical properties of the target tissue with a sensor on an ablationcatheter.
 8. The graphical user interface system of claim 1, wherein thesystem is configured to store a first color associated with a firstrange of predicted depth values of the lesion in the target tissue forthe time period.
 9. The graphical user interface system of claim 8,wherein the system is configured to store a second color associated witha second range of predicted depth values of the lesion in the targettissue for the time period.
 10. The graphical user interface system ofclaim 9, wherein the system is configured to store a third colorassociated with a third range of predicted depth values of the lesion inthe target tissue for the time period.
 11. The graphical user interfacesystem of claim 10, wherein the display device is configured to displaya color associated with the predicted depth value of the lesion in thetarget tissue for the time period.
 12. The graphical user interfacesystem of claim 1, wherein the visual representation of the predicteddepth value of the lesion in the target tissue for the time periodcomprises a gauge including a scale and an indicator moveable along thescale that graphically indicates the predicted depth value of the lesionin the target tissue for the time period.
 13. The graphical userinterface system of claim 1, wherein the display device is furtherconfigured to display a visual representation indicative of an ablationcatheter used to perform the ablation procedure.
 14. The graphical userinterface system of claim 13, wherein the visual representationindicative of the ablation catheter used to perform the ablationprocedure includes a first view along a first axis of a body upon whichthe ablation procedure is performed and includes a second view along asecond axis of the body upon which the ablation procedure is performed.15. The graphical user interface system of claim 1, wherein the displaydevice is further configured to display a visual representationindicative of the transmurality of a lesion in the target tissue. 16.The graphical user interface system of claim 1, wherein the ECU isconfigured to store the predicted depth value, to retrieve the storedpredicted depth value subsequent to the time period, and to output thestored predicted depth value to the display device subsequent to thetime period, and wherein the display device is configured to display avisual representation of the stored predicted depth value of the lesionin the target tissue subsequent to the time period.
 17. The graphicaluser interface system of claim 1, wherein the display device is furtherconfigured to display a slider bar configured to adjust a thresholdagainst which the predicted depth value of the lesion in the targettissue may be compared, thereby adjusting a sensitivity of the graphicaluser interface system.
 18. A system for displaying characteristics oftarget tissue during an ablation procedure, the system comprising: anablation catheter including a first sensor configured for obtaining dataregarding a complex impedance measured between a first electrode and thetarget tissue for a time period during the ablation procedure and asecond sensor configured for obtaining data regarding a contact forcemeasured between a second electrode and the target tissue for the timeperiod, wherein the time period is a time during which ablation energyis applied to the target tissue; an electroanatomic visualization,mapping, and navigation system configured for generating an anatomicalmodel of at least the target tissue, the electroanatomic visualization,mapping, and navigation system including a display device for displayingthe anatomical model; and a graphical user interface system comprising:an electronic control unit (ECU) configured to receive as an input datathe complex impedance for the time period; receive as an input data athickness of the target tissue; receive as an input data a signalindicative of the contact force for the time period; determine apredicted depth value of a lesion in the target tissue based on each ofthe following: i) the complex impedance, ii) the time period, and iii)the signal indicative of the contact force; associate the predicteddepth value with the thickness of the target tissue; and output thepredicted depth value; wherein the display device is operativelyconnected to the ECU and is configured to receive the predicted depthvalue and to display i) a visual representation of the predicted depthvalue of the lesion in the target tissue for the time period and ii) avisual representation of the thickness of the target tissue.
 19. Thesystem of claim 18, wherein the visual representation of the predicteddepth value of the lesion in the target tissue for the time periodappears as an inset on the display device of the electroanatomicvisualization, mapping, and navigation system.
 20. The system of claim18, wherein the display device is further configured to display a visualrepresentation indicative of a location of the ablation catheter used toperform the ablation procedure relative to the anatomical modelgenerated by the electroanatomic visualization, mapping, and navigationsystem.
 21. The system of claim 18, wherein at least one of the displaydevice and the ablation catheter is configured to present at least oneof an audible indication, a tactile indication, and a vibrationalindication if the predicted depth value of the lesion in the targettissue for the time period exceeds a predetermined threshold.
 22. Amethod for displaying characteristics of target tissue during anablation procedure, the method comprising: obtaining data regarding athickness of the target tissue; displaying a visual representationindicative of the thickness of the target tissue; obtaining dataregarding a complex impedance measured between a first electrode and thetarget tissue for a time period during the ablation procedure, whereinthe time period is a time during which ablation energy is applied to thetarget tissue; obtaining data regarding a contact force measured betweena second electrode and the target tissue for the time period;determining a predicted depth value of a lesion in the target tissuebased on each of the following: (i) the data regarding the compleximpedance, (ii) the time period, (iii) and the data regarding thecontact force; associating the predicted depth value with the thicknessof the target tissue; and displaying a visual representation of thepredicted depth value of the lesion in the target tissue for the timeperiod.